Good news! Cancer is history (soon)!
This is an alarming finding!
"... that nearly half of high-risk prostate cancer patients previously classified as nonmetastatic by conventional imaging actually have metastatic disease when evaluated with advanced prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging, suggesting that traditional imaging may underestimate how far the cancer has spread in many cases. ...
This advanced imaging technology plays a critical role in redefining how prostate cancer is staged. PSMA-PET imaging uses tiny amounts of radioactive “tracers,” called radiotracers, that bind to prostate cancer cells, making them visible on PET scans. Unlike conventional imaging, which provides only anatomical details, PSMA-PET offers functional imaging that reveals the cancer’s biological activity, which can significantly improve the accuracy of disease staging. ..."
From the key points and abstract:
"Key Points
Question
What prostate-specific membrane antigen–positron emission tomographic/computed tomographic (PSMA-PET/CT) findings are present among patients with high-risk biochemically recurrent hormone-sensitive prostate cancer that is nonmetastatic as determined using conventional imaging?
Findings
This cross-sectional post hoc analysis included 182 patients with high-risk nonmetastatic hormone-sensitive prostate cancer from 4 prospective studies who were eligible for the EMBARK study. Patients’ cancers were understaged by conventional imaging; PSMA-PET results were positive in 84% of patients, PSMA-PET detected M1 disease stage in 46% of patients and found polymetastatic disease (≥5 lesions) in 24% of patients.
Meaning
Further studies are needed to assess the independent prognostic value of PSMA-PET and its use for treatment guidance.
Abstract
Importance
The phase 3 randomized EMBARK trial evaluated enzalutamide with or without leuprolide in high-risk nonmetastatic hormone-sensitive prostate cancer. Eligibility relied on conventional imaging, which underdetects metastatic disease compared with prostate-specific membrane antigen–positron emission tomography (PSMA-PET).
Objective
To describe the staging information obtained by PSMA-PET/computed tomography (PSMA-PET/CT) in a patient cohort eligible for the EMBARK trial.
Design, Setting, and Participants
This post hoc, retrospective cross-sectional study included 182 patients from 4 prospective studies conducted from September 15, 2016, to September 27, 2021. All patients had recurrent prostate cancer after radical prostatectomy (RP), definitive radiotherapy (dRT), or salvage radiotherapy (SRT). Analysis was performed from January 2023 to July 2024.
Exposures
Patients included had increasing prostate-specific antigen (PSA) levels greater than 1.0 ng/mL (after RP and SRT) or 2.0 ng/mL above the nadir value (after dRT), PSA doubling time of 9 months or less, and a serum testosterone level of 150 ng/dL or greater. Exclusion criteria were distant metastatic disease on radiographic imaging and prior hormonal or systemic therapy.
Main Outcomes and Measures
Staging information obtained by PSMA-PET/CT in patients with nonmetastatic disease according to conventional imaging.
Results
...
Conclusions and Relevance
In a cohort of patients with high-risk hormone-sensitive prostate cancer without evidence of metastatic disease by conventional imaging, PSMA-PET results were positive in 84% of patients, detected M1 disease stage in 46% of patients, and found polymetastatic disease (≥5 lesions) in 24% of patients, suggesting that patients’ high-risk nonmetastatic hormone-sensitive prostate cancers are understaged by conventional imaging. The results challenge the interpretation of previous studies, such as the EMBARK trial, and support the evolving role of PSMA-PET for patient selection in clinical and trial interventions in prostate cancer. Further studies are needed to assess its independent prognostic value and use for treatment guidance."
PSMA-PET/CT images of an 85-year-old patient with hormone-sensitive prostate cancer. The whole-body PET image (see right) shows two areas of focally increased PSMA tracer uptake in the pelvis, suspicious for metastatic disease (see yellow arrows).
While CT images show unremarkable pelvic lymph nodes (see bottom left, lymph node size: 1.1 cm x 0.7 cm),
intense focal tracer uptake on PSMA-PET (see top left, SUVmax 7.1) indicates the presence of lymph node metastases (see arrows).
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