Advanced imaging detects prostate cancer spread better than x-rays or CT-scans
CANCER DIGEST – Jan. 5, 2025 – Nearly half of high-risk prostate cancer patients classified as not having cancer spread to other parts of the body by conventional imaging, actually have metastatic cancer as shown using more intensive imaging, a new study shows.
The study of 182 men who were judged to have non-metastatic prostate cancer recurrence after having their prostate removed surgically or with radiotherapy was led by Dr. Jeremie Calais of the David Geffen School of Medicine at the University of California.
Published in the Jan. 3, 2025 journal JAMA Network Open, the study looked at data from a previous trial involving men whose recurrent prostate cancers were considered high-risk, but thought to be contained or localized to the prostate using conventional imaging.
“Our study demonstrates the critical role of PSMA-PET in accurately staging prostate cancer,” senior author of the study Dr. Calais said in a press release, "which can significantly impact treatment decisions and outcomes.”
Prostate-specific membrane antigen positron tomography scan or PSMA-PET imaging uses a radioactive agent injected into the body that attaches to PSMA proteins found on the surface of prostate cells. When scanned the radioactive agent shows on the image, revealing anywhere on the body that prostate cancer cells have migrated.
In the trial, the researchers found that PSMA-PET detected cancer spread in 46 percent of the patients thought to have no cancer spread as a result of conventional imaging. In 24 percent of those patients the PSMA-PET scans showed cancer in 5 or more places in the body that had been missed by conventional imaging.
The result challenges not only reliance on conventional imaging for making treatment decisions but also results of previous clinical trials whose inclusion criteria specified non-metastatic prostate cancer based on conventional imaging. If those clinical trials were based on men without metastatic disease and up to 46 percent in fact did have cancer spread, then the interpretation of the results from those trials could be open to re-interpretation.
Nevertheless, the researchers caution that more studies like this one need to be done to change clinical practice.
“We have good rationales to assume that it is helpful to primarily rely on PSMA-PET findings,” first author Dr. Holzgreve said in a press release. “But more high-quality prospective data would be needed to claim superiority of PSMA-PET for treatment-guidance in terms of patient outcome. However, we are confident PSMA-PET will continue to advance prostate cancer staging and guide personalized therapies.”
Sources: David Geffen School of Medicine at UCLA press release, and JAMA Network
Kommentit