PSMA PET/CT Helps Guide Pre-Biopsy Decisions in Prostate Cancer

Prostate cancer evaluation often begins with prostate-specific antigen (PSA) testing, but elevated levels are not specific to cancer and can lead to unnecessary biopsies. These procedures carry risks of bleeding and infection and may lead to diagnoses that result in overtreatment, underscoring the need for better pre-biopsy risk assessment. To help refine biopsy decisions, researchers have evaluated prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) as an early diagnostic tool.

The Medical University of Vienna assessed PSMA-PET/CT for patients with elevated PSA and suspected prostate cancer before biopsy. The modality combines positron emission tomography, using a radiotracer that binds to the prostate-specific membrane antigen highly expressed on prostate cancer cells, with simultaneous computed tomography for precise anatomical localization. The approach is designed to visualize suspicious intraprostatic regions and align them with structural landmarks to support targeted decision-making.

In an analysis of 194 patients drawn from the randomized, phase 3 RAPID trial, PSMA-PET/CT detected 91% of clinically significant prostate cancers confirmed on histology. Of 77 men with clinically significant disease, 70 were identified on imaging. A normal scan result was also informative, as 91% of these cases had no clinically significant tumor on biopsy. During a median follow-up of 35 months, 23 of 24 patients who later developed an aggressive disease course had already been flagged as positive on PSMA-PET/CT.

The findings were published in the inaugural issue of The Lancet Medical Imaging & Theranostics. The results indicate that PSMA-PET/CT could inform initial diagnostic workups and help determine which patients actually require tissue sampling. Further studies are needed to establish how this method could be integrated into routine diagnostic pathways.

“Our results show that PSMA-PET/CT may be able to provide valuable information at a very early stage of the diagnostic workup. The high diagnostic value of a normal result is particularly relevant here. In the future, this could help make better decisions about which patients actually require a biopsy,” said Marcus Hacker, head of the Division of Nuclear Medicine at the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna.

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