PSMA-PET Reliable for Prostate Cancer Detection in Radical Prostatectomy

A recent study toward more precise prostate cancer detection found the potential of PSMA-PET (prostate-specific membrane antigen-positron emission tomography) in biopsy-free radical prostatectomy. According to the study, this procedure relies on prior biopsies, but the PSMA-PET approach could revolutionize this norm. The findings of the research were published in the Journal of Urology.

This retrospective study analyzed the intersection of PSMA-PET, benign prostatic hyperplasia (BPH), and prostate cancer. The major concern was the expression of PSMA in BPH tissue, which could lead to false positives. The study, a first in its kind, unveiled a BPH-related false-positive rate of 30% in PSMA-PET's detection of prostate cancer.

The research also found the significance of the maximum standardized uptake value (SUVmax) and the Prostate Imaging Reporting & Data System (PI-RADS) in steering biopsy-free radical prostatectomy. The SUVmax emerged as a critical parameter, effectively excluding BPH and low-grade prostate cancer patients. An optimal SUVmax cutoff value of 15 exhibited 100% specificity but with a sensitivity of 41%.

The stringent PET scores and PI-RADS criteria (both ≥4) showed promising results in diagnosing clinically significant prostate cancer, achieving a sensitivity of 49% and 100% specificity.

These findings mark a significant step toward biopsy-free radical prostatectomy while caution is warranted. The study underscores the need for further research, especially in large-scale clinical trials, to solidify the efficacy and safety of PSMA-PET in managing prostate cancer. As discussions on the broader implications of this breakthrough unfold, the patients are reminded to prioritize evidence-based, standard-of-care treatments until a clearer consensus emerges.

Reference:

Tang, W., Tang, Y., Qi, L., Zhang, Y., Tang, G., Gao, X., Hu, S., & Cai, Y. (2023). Benign Prostatic Hyperplasia–Related False-Positive of Prostate-Specific Membrane Antigen–Positron Emission Tomography in the Diagnosis of Prostate Cancer: The Achilles’ Heel of Biopsy-Free Radical Prostatectomy? In Journal of Urology (Vol. 210, Issue 6, pp. 845–855). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ju.0000000000003680