In a best practice report published in the June issue of the Canadian Urological Association Journal, current and evolving indications are presented for the use of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) in patients with high-risk prostate cancer.
Bobby Shaygan, MD, from McMaster University in Hamilton, Ontario, Canada, and colleagues note that current data strongly suggest that the performance of PSMA-targeted PET is superior to conventional imaging for characterizing prostate cancer across the spectrum of disease. PSMA-targeted PET is useful for staging primary, high-risk prostate cancer and for restaging biochemically recurrent disease after primary therapy. PSMA-targeted PET may be considered for patients with high-risk or very high-risk prostate cancer in whom imaging with conventional modalities fails to demonstrate metastatic disease and where its identification would result in a change in treatment. Identification of metastases by PSMA-targeted PET may allow for inclusion into clinical trials among patients with nonmetastatic, castration-resistant prostate cancer for whom prostate-specific antigen kinetics are favorable and where systemic treatment intensification is not warranted.
“Despite the superior detection of disease by PSMA-targeted PET, it must be emphasized that to date, there is no evidence to support that such enhancements have led to improved clinical outcomes,” the authors write. “Ongoing research will help clarify the long-term impact of PSMA-targeted PET on patient outcome, as well as to better define the relative strengths and weakness of the individual available PSMA-targeted PET radiopharmaceuticals.”
One author disclosed financial ties to the pharmaceutical industry.