The role of PSMA PET/CT to predict upgrading in patients undergoing radical prostatectomy
This study aimed to find out if prostate-specific membrane antigen (PSMA) positron emission
© Sanford Radom, MD
tomography/computed tomography (PET/CT) can predict cancer progression in patients with
low-grade prostate cancer. These patients had been diagnosed with Grade Group (GG) 1 prostate cancer through biopsy. The researchers wanted to see if PSMA PET/CT could add useful information to what doctors already know from multiparametric magnetic resonance imaging (mpMRI) and clinical data.
The study included 41 patients who had radical prostatectomy for GG1 prostate cancer. All of them had PSMA PET/CT scans and mpMRI images taken before the surgery. The researchers looked at whether these patients’ final pathology reports after surgery showed signs of more aggressive cancer (upgrading to GG2 or higher).
The results showed that 26 out of 41 patients (about 66%) had cancer that was more aggressive
than initially thought. Most were upgraded to GG2, with one patient upgrading to GG4. When
looking at the imaging results, 78% of patients with the highest risk mpMRI category (PIRADS-5) had upgraded cancers, and 74% of those with PIRADS-4 were also upgraded. Only 38% of patients with lower-risk PIRADS scores (PIRADS ≤ 3) were upgraded.
PSMA PET/CT scans also helped predict which patients had more aggressive cancer.
The authors concluded that high PSMA uptake in PET/CT scans is a strong indicator of more aggressive cancer in patients with GG1 prostate cancer, but low uptake doesn’t mean the cancer won’t be upgraded. Combining PSMA PET/CT with mpMRI and other clinical information can help physicians make better treatment decisions.
Baris Esen The Prostate, 2024-01, Vol.84 (1), p.32-38
