Prostate-specific PET/CT finds elusive cancers, fine-tunes care management

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 - ProstateC
Prostate-specific PET/CT of a 77-year-old man with recurrent lymph node and pulmonary metastases that were previously missed by conventional imaging. (Credit: Royal North Shore Hospital, Sydney, via SNMMI.)

A high proportion of prostate cancer patients have their care pathways changed after being scanned with PET/CT enhanced by the injected radiotracer gallium-68 (Ga-68) and prostate-specific membrane antigen (PSMA).

In the prospective, multicenter study behind the finding, the patients most impacted were those for whom the prostate-specific molecular imaging yielded detection of previously unsuspected disease and those whose cancer came back after surgery and/or radiation therapy.

The research was presented at last week’s annual meeting of the Society of Nuclear Medicine and Molecular Imaging in Denver and, in May, published in SNMMI’s Journal of Nuclear Medicine.

Paul Roach, MBBS, chief of nuclear medicine at Royal North Shore Hospital in Sydney, Australia, and colleagues analyzed data on 431 patients who had pre- and post-Ga68 PSMA management plans completed by their referring specialists.

Surveying the clinicians after the imaging, Roach and colleagues found more than half the patients, 51 percent, had been redirected on their course of care.

Among patients with recurring cancers, the change in care management affected 61 percent.

For those who had undergone surgery, the change-in-care response reached and eye-opening 69 percent.

Further, the PET/CT scanning with Ga68 PSMA detected disease that was not previously suspected in the prostate bed (30 percent of patients), locoregional lymph nodes (36 percent) and distant metastasis (16 percent).

In a press release sent by SNMMI from the conference, Roach calls prostate-specific PET/CT a game-changer.

“This is likely to become the primary imaging test for many patients with prostate cancer and will replace conventional imaging in many cases,” he says. “Given the prevalence of prostate cancer, this could lead to a significant increase in referrals to nuclear medicine and PET centers for Ga-68 PSMA PET/CT imaging worldwide.”