Newly Published Appropriate Use Criteria for PSMA PET Imaging

By Robert Dillard - Last Updated: January 11, 2022

The Society of Nuclear Medicine and Molecular Imagining (SNMMI) in conjunction with peer medical groups recently issued appropriate use criteria (AUC) for prostate-specific membrane antigen (PSMA) PET imaging. The criteria appeared in The Journal of Nuclear Medicine (JNM) and include a list of relevant clinical scenarios, a systematic review of evidence in the literature, as well as a systematic analysis of available evidence.

The article consists of 11 scenarios for patients with prostate cancer, ranging from initial staging to biochemical recurrence to  castration-resistant prostate cancer. Each specific scenario is deemed as “appropriate,” “may be appropriate” or “rarely appropriate” based on evidence and expert opinion regarding diagnostic accuracy, as well as effects on clinical outcomes and clinical decision making. Other factors impacting AUC scoring included potential harm, costs, availability, and patient preferences.

A multipronged approach will be used to disseminate the AUC for PSMA PET in prostate cancer to all relevant stakeholders—including physicians, nuclear medicine physicians, and patients. Tactics for effective dissemination will consist of a mix of outreach and educational activities, intended to targeted to each of these audiences. Moreover, the SNMMI intendeds to develop a mobile application for the AUC across both Apple and Android platforms.

The AUC were developed by a multidisciplinary panel including representatives from SNMMI and the American College of Nuclear Medicine, American College of Physicians, American Society of Clinical Oncology, American Urological Association, Australian and New Zealand Society of Nuclear Medicine, and European Association of Nuclear Medicine.

“The Food and Drug Administration recently approved two PSMA PET agents—18F-DCFPyL and 68Ga-PSMA-11—for diagnostic imaging of patients with suspected or known prostate cancer. With these approved imaging agents, plus more on the horizon, the development of AUC was necessary to aid referring medical practitioners in appropriate use of PSMA PET imaging for their patients,” said Hossein Jadvar, MD, PhD, MPH, MBA, FACNM, FSNMMI, professor of radiology, urology, and biomedical engineering at the Keck School of Medicine & Viterbi School of Engineering at the University of Southern California in Los Angeles and a past president of SNMMI via a press release.

Dr. Jadvar added that: “The development and use of AUC documents for advanced diagnostic imaging services is an important process in providing patients with appropriate imaging care. These criteria will be instrumental in improving patient outcomes and reducing overall cost to the healthcare system.”