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PSMA PET/CT and PET/MRI in primary staging of prostate cancer and its effect on patient management

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Abstract

Purpose

In the last decade, prostate specific membrane antigen (PSMA) positron emission tomography (PET) has gained its role as a novel tool in the primary staging of prostate cancer (PCa). This review focuses on the current knowledge on PSMA PET in primary PCa staging, which includes the Tumor-, Node-, Metastasis- (T-, N-, M-) staging, and the impact of PSMA PET on patient management.

Methods

A literature search was performed in all databases of Web of Science for peer-reviewed, original studies published in English until June 2022. The results were screened by abstract in the setting of primary staging of PCa, using PSMA PET tracers for imaging modalities PET/computed tomography (CT) and PET/magnetic resonance imaging (MRI).

Results

The available literature shows that PSMA PET is an accurate test in the primary staging of PCa. For T-staging, the combination of PSMA PET with the current gold standard multi-parametric MRI (mpMRI) may have a synergistic impact for assessment of tumor volume. For N- and M-staging, multiple studies show that PSMA PET clearly outperforms current conventional imaging modalities, which is also confirmed in the proPSMA randomized controlled trial that revealed a 27% higher accuracy of PSMA PET compared to conventional imaging. Several studies show that PSMA PET, due to its high accuracy, can lead to treatment adaption.

Conclusions

Despite the clear superiority of PSMA PET over conventional imaging for primary staging of intermediate- and high-risk PCa, PSMA PET is currently not yet identified as the gold standard imaging modality in this setting in the European Association of Urology (EAU) guidelines, given that no prospective studies demonstrating a clear benefit of treatment adaptation are available at this moment. The results of prospective trials exploring the benefit of PSMA PET-based treatment algorithms are, therefore, strongly awaited.

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Acknowledgements

NAB is a PhD fellow at the Research Foundation-Flanders (FWO), project number 1SB8923N. CMD is a senior clinical investigator at the Research Foundation-Flanders (FWO).

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  1. Department of Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Pieter Claes, Niloefar Ahmadi Bidakhvidi, Koen Van Laere, Michel Koole, Sander Jentjens, Christophe M. Deroose & Karolien Goffin

  2. Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, 3000, Leuven, Belgium

    Niloefar Ahmadi Bidakhvidi, Koen Van Laere, Michel Koole, Christophe M. Deroose & Karolien Goffin

  3. Department of Urology, University Hospitals Leuven, 3000, Leuven, Belgium

    Alexander Giesen & Steven Joniau

  4. Urogenital, Abdominal and Plastic Surgery, Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium

    Alexander Giesen & Steven Joniau

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Claes, P., Ahmadi Bidakhvidi, N., Giesen, A. et al. PSMA PET/CT and PET/MRI in primary staging of prostate cancer and its effect on patient management. Clin Transl Imaging 12, 31–54 (2024). https://doi.org/10.1007/s40336-023-00582-4

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