Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown a high detection rate for distant metastatic disease among patients with high-risk, nonmetastatic hormone-sensitive prostate cancer (nmHSPC), according to a study published online on January 3 in JAMA Network Open.

The study, led by Adrien Holzgreve, M.D. from the University of California, Los Angeles, analyzed data from 182 patients with high-risk nmHSPC across four prospective studies conducted between September 2016 and September 2021. The patients underwent PSMA-PET/computed tomography (CT) following radical prostatectomy (RP), definitive radiotherapy (dRT), or salvage radiotherapy (SRT).

Results revealed that 84 percent of patients had positive PSMA-PET findings, significantly enhancing the staging information available compared to conventional imaging techniques. Importantly, 46 percent of patients had evidence of distant metastatic disease. These findings varied across treatment groups, with the highest detection rates seen in patients after definitive radiotherapy, where 92 percent had positive PSMA-PET results and 56 percent showed distant metastasis.

The study also highlighted the detection of polymetastatic disease in 24 percent of patients overall, with rates reaching as high as 36 percent in patients post-definitive radiotherapy. Median prostate-specific antigen (PSA) levels prior to scanning ranged between 2.4 and 6.9 ng/mL depending on treatment groups, reflecting the variation in disease progression and patient staging.

These findings underscore the potential of PSMA-PET as a superior imaging modality for risk stratification in high-risk nmHSPC. The authors emphasized its role in providing critical additional information not available through conventional imaging, which could lead to improved treatment strategies.

"PSMA-PET provides novel additional risk stratification for patients with high-risk nmHSPC without distant metastasis based on conventional imaging," the authors wrote, advocating for its integration into major industry-sponsored clinical trials to refine secondary endpoint analyses.

The study bolsters the growing evidence for PSMA-PET as a transformative tool in prostate cancer management, offering clinicians a more precise approach to identifying and addressing metastatic disease in high-risk patients.