PSMA-PET/CT May Help Improve Clinical Treatment of Prostate Cancer

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A trial conducted at the University Hospital Bonn, Germany, has been testing the benefit of PSMA-PET/CT (prostate-specific membrane antigen–positron-emission tomography/computed tomography) to help target where to take biopsy samples, potentially improving the diagnosis of prostate cancer by giving a clearer view of suspected tumors. The study findings were presented by Krausewitz et al at the 2023 European Association of Urology (EAU) Annual Congress in Milan (Abstract A0056).

Interim results of the study revealed that when used alongside standard imaging techniques, the additional scans might help clinicians make improved decisions about subsequent courses of treatment. Compared to the standard scans alone, when PSMA-PET/CT was used, clinicians changed how they might treat a patient with clinically significant prostate cancer in 19% of cases. The technique also helped detect significantly more clinically significant prostate cancers.

“The normal standard of care, which is an MRI [magnetic resonance imaging] scan and then a biopsy, is already good at detecting of prostate cancer, but we wanted to see if PSMA-PET/CT could offer additional information to help with treatment plans,” said Philipp Krausewitz, MD, a urologist at University Hospital Bonn who led the study. “It appears to be having an impact in high-risk patients, but we also saw false-positives in 6% of patients, which means we need further investigations. The question we are considering is whether the additional diagnostics are worthwhile.”

Study Details

The study, known as the DEPROMP trial, has recruited around 200 men to take part since March 2021. The researchers are hoping to have 230 patients enrolled by the end of the trial. The preliminary results used data from 219 men who all underwent MRI, PSMA-PET/CT, and biopsy.

Their scans were then randomly looked at by two separate teams of urologists–one was given the results from the MRI, PSMA-PET/CT, and biopsy, while the other group was given the results without the PSMA-PET/CT data. The researchers then compared how the two teams would choose to proceed with treatment based on the information they had.

However, it is not yet clear how these decisions might ultimately affect patient outcomes, as it can take years and even decades for cancer to return if treated correctly.

Practical Implications

“We are seeing a change in cancer detection and management plans in these early results, but we have to wait to see if the final results reflect this,” said Dr Krausewitz. “PSMA-PET/CT is not yet available everywhere, as it is expensive, so it is important we understand how it can be effectively used.”

With health-care systems already under financial strain, the technique will need to offer a substantial improvement in diagnostic capability to be cost effective, added Jochen Walz, MD, Associate Professor of Urology at the Institut Paoli-Calmettes Cancer Centre in Marseille, France, who commented on the research on behalf of the EAU.

He said: “In the meantime, PSMA-PET/CT could be considered a solution for selected challenging diagnostic cases or those where MRI cannot be done.”

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