Endocrine Abstracts

Introduction: Conventional imaging for prostate cancer typically utilizes cross-sectional CT and MRI scanning, along with Tc99 bone scanning for bone metastases. All of these modalities have relatively poor sensitivity and specificity, particularly for men with suspected recurrence following radical prostatectomy or radiotherapy. PSMA PET is rapidly emerging as a superior imaging option.

Objective: To give a clinical perspective of the role PSMA PET for staging recurrent and high-risk prostate cancer.

Evidence overview: PSMA PET has provided a significant advance in imaging sensitivity and specificity for men with biochemical recurrence following previous definitive treatment. Recurrence can be identified in up to 50% of men with PSA levels below 0.5 ng/ml post-radical prostatectomy. However the decision impact of this is unclear. PSMA PET also appears sensitive for recurrence following primary radiotherapy. The role of PSMA PET for staging primary localised prostate cancer, especially lymph node staging in high-risk localised prostate cancer, is under evaluation with encouraging early data.Overall, PSMA performs much better than conventional imaging and much better than other PET tracers such as choline. It is also much more accessible and affordable in regions in which is has become popularised. PSMA PET also offers theranostic possibilities adding another dimension to its utility.

Conclusions: PSMA PET is an exciting new option for imaging in prostate cancer and greatly outperforms existing imaging modalities for recurrent and higher risk localised prostate cancer. However prospective studies are required to define its optimal role and to measure decision impact. Theranostic possibilities are also of clinical interest for advanced prostate cancer.