Understanding PSMA PET/CT's Role in Staging Intermediate-Risk Prostate Cancer

What is it about?

This article systematically reviews and synthesizes data on the diagnostic utility of PSMA PET/CT in staging intermediate-risk prostate cancer (PCa). It focuses on studies involving patients categorized under EAU/NCCN intermediate-risk or Gleason Score 7 (ISUP GG 2-3) PCa, aiming to evaluate the effectiveness of PSMA PET/CT scans in detecting lymph nodes or distant metastases. The review includes 16 studies, finding a wide range of positivity rates from 2.2% to 50.0%, with a pooled analysis indicating a 9% positivity rate. The article highlights that PSMA PET/CT has low sensitivity (33%) for detecting nodal and metastatic disease in intermediate-risk PCa, particularly in favourable cases. Despite these findings, PSMA PET/CT may offer prognostic benefits, such as aiding in risk stratification for active surveillance. The study concludes by emphasizing the need for robust, prospective research to better define the diagnostic role of PSMA PET/CT in managing unfavourable intermediate-risk PCa.

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Why is it important?

This review examines the diagnostic utility of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the context of intermediate-risk prostate cancer (PCa). Its significance lies in addressing the current uncertainty regarding the role of PSMA PET/CT for this patient group, given its established utility in high-risk PCa. By synthesising existing data, the review aims to clarify PSMA PET/CT's potential application in primary staging and guide future clinical decision-making and guideline development. Key Takeaways: 1. This review article summarises that PSMA PET/CT exhibits a low positivity rate in primary staging of intermediate-risk PCa, with a pooled positivity rate of 9%, suggesting limited utility in this patient group. 2. The review highlights that PSMA PET/CT has a low sensitivity of 33% for detecting nodal and metastatic disease in intermediate-risk PCa, underscoring its limitations as a diagnostic tool in this context. 3. This review article compiles current evidence showing a lack of consensus in guidelines regarding the routine use of PSMA PET/CT for intermediate-risk PCa, emphasizing the need for further prospective studies to define its role in clinical practice.