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PSMA-PET/CT comparable to MRI for detecting prostate cancer

The findings suggest that PSMA-PET/CT holds promise as an alternative for detecting prostate cancer – good news for patient care, wrote a team led by Dr. Lih-Ming Wong of St. Vincent’s Hospital in Melbourne, Australia.

“This study confirms that the existing ‘gold standard’ of prebiopsy detection – MRI – is indeed a high benchmark,” Wong said in a statement released by the company. “Even with fine-tuning, we suspect that PSMA-PET/CT will not replace MRI as the primary method for detecting prostate cancer. But it will likely have application in the future as an adjunct to MRI, or for people for whom an MRI is not suitable, or as a single combined ‘diagnosis and staging’ test for appropriately selected patients.”

The U.S. Food and Drug Administration (FDA) cleared the imaging agent gallium-68 (Ga-68) PSMA-11 for PSMA-PET/CT scans in 2020; a second agent, Pylarify, was licensed in 2021. Previous studies have suggested that PSMA-PET is a comparable tool to MRI for detecting clinically significant tumors in patients with prostate cancer.

Wong’s group sought to explore this theory further via a study that included 240 patients at risk for prostate cancer. Each underwent an MRI examination and a PSMA-PET/CT scan; if imaging indicated the presence of prostate cancer, patients underwent a biopsy.

MRI found abnormalities suggestive of prostate cancer in 141 patients, and PSMA-PET/CT scans found abnormalities in 198 patients. Of the 240 people included in the study, 181 (75%) underwent a biopsy, and 82 of these were confirmed to have “clinically significant” prostate cancer, as defined by the relatively new from the International Society of Urologic Pathologists (ISUP). for cancer severity.

Although PSMA-PET/CT imaging found more abnormalities than MRI scans, MRI was more accurate in identifying prostate cancer grade than PSMA-PET/CT, at 75% versus 62%, noted the team. But the two modalities were comparable when it came to identifying clinically significant prostate cancer, Wong noted.

“Our analysis found that MRI scans were better than PSMA-PET at detecting any grade of prostate cancer… [but] when we only looked at clinically significant prostate cancers, there was no difference in accuracy,” he said.

PSMA-PET/CT offers a good alternative to MRI for diagnosing prostate cancer, but more research is needed, said Dr. Peter Albers of the Heinrich-Heine University of Düsseldorf in Germany and chairman of the scientific director of the EAU, in the press release.

“Further research will be needed to explore the PSMA-PET/CT correlation between standard uptake value and cancer aggressiveness, but the first steps on the road to finding the best diagnostic approach for clinically significant prostate cancer have been crossed,” he said.

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