Advanced Imaging Reveals Undetected Metastases in High-Risk Prostate Cancer Patients: Study Finds - Video

A new study published in JAMA Network Open found that nearly half of high-risk prostate cancer patients previously classified as nonmetastatic by conventional imaging actually have metastatic disease when evaluated with advanced prostate-specific membrane antigen–positron emission tomography (PSMA-PET) imaging, suggesting that traditional imaging may underestimate how far the cancer has spread in many cases. The findings are published in

JAMA Network Open.

To better understand the advantages of PSMA-PET over conventional imaging, researchers conducted a post hoc, retrospective cross-sectional study using data from 182 patients with high-risk recurrent prostate cancers who were thought to have disease limited to the prostate and were eligible for the EMBARK trial.

This clinical trial previously demonstrated that adding enzalutamide, a type of hormone therapy, to androgen deprivation therapy significantly improves metastasis-free survival. However, the trial relied on conventional imaging to classify patients, which researchers believe might have underestimated the disease's extent in some cases.

The researchers found PSMA-PET detected cancer metastases in 46% of patients, even though traditional imaging had suggested no evidence of cancer spread. Based on PSMA-PET, 24% of the patients even showed 5 or more lesions that had been missed by conventional imaging.

This advanced imaging technology plays a critical role in redefining how prostate cancer is staged. PSMA-PET imaging uses tiny amounts of radioactive “tracers,” called radiotracers, that binds to prostate cancer cells, making them visible on PET scans.

Reference: Holzgreve A, Armstrong WR, Clark KJ, et al. PSMA-PET/CT Findings in Patients With High-Risk Biochemically Recurrent Prostate Cancer With No Metastatic Disease by Conventional Imaging. JAMA Netw Open. 2025;8(1):e2452971. doi:10.1001/jamanetworkopen.2024.52971