PSMA PET-CT in Metastatic Prostate Cancer: A Real-World Analysis

What is it about?

The Medicare Benefits Schedule in Australia has decided to fund PSMA PET-CT imaging for staging of localised intermediate-or high-risk prostate cancer and in the setting of biochemical recurrence from 1 July 2022. However, the benefits of PSMA PET-CT compared to conventional CT and WBBS have not been well established in metastatic castration-resistant prostate cancer (mCRPC). The use of PSMA PET-CT imaging in mCRPC may impact treatment decisions, such as being a predictive biomarker for lutetium (Lu)-PSMA therapy and identifying oligometastatic prostate cancer. The study examined the real-world use of PSMA PET-CT imaging in the Australian CRPC setting, identifying 90 patients who underwent PSMA PET-CT before first-line systemic therapy for mCRPC between 2013 and 2019. The majority of patients (57 [63%]) underwent PSMA PET with low-dose CT alone. Among the 33 patients with any conventional imaging for comparison, 12 (36%) had additional metastases identified on PSMA PET-CT, including five at new sites of metastatic disease.

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Why is it important?

The research is important as it examines the real-world use of PSMA PET-CT imaging in the Australian CRPC setting, which has increasing clinical applicability. It identifies men who underwent PSMA PET-CT before first-line systemic therapy for mCRPC, using the multicentre electronic CRPC Australian Database (ePAD). The imaging reports were retrospectively reviewed, and sites of metastatic disease were recorded, as determined by the reporting doctors. The study aims to determine the additional value of PSMA PET-CT imaging in detecting metastatic disease and its impact on clinical decision-making, treatment response, and patient outcomes in the mCRPC setting. Key Takeaways: 1. PSMA PET-CT imaging demonstrated greater sensitivity compared to conventional imaging modalities with CT and whole-body bone scan (WBBS) in the detection of metastatic prostate cancer. 2. In mCRPC, PSMA PET-CT imaging use changed management in 61% of patients. 3. PSMA PET-CT imaging may detect mCRPC in those with non-mCRPC (M0) on conventional imaging 4. Oligometastatic prostate cancer in hormone-sensitive prostate cancer (HSPC) has emerging significance, given increasing evidence for metastasis-directed therapy improving androgen-deprivation therapy-free survival.