PSMA-PET leverages ‘radiotracers’ that bind to prostate cancer cells, making them visible on PET scans. Credit: Nemes Laszlo / Shutterstock.

A new UCLA Health Jonsson Comprehensive Cancer Center-led study has revealed that advanced prostate-specific membrane antigen positron emission tomography (PSMA-PET) imaging could reveal metastatic disease in individuals with high-risk nonmetastatic hormone-sensitive prostate cancer.

PSMA-PET leverages ‘radiotracers’ that bind to prostate cancer cells, making them visible on PET scans and providing functional imaging that reveals the biological activity of cancer.

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This functional imaging can significantly ‘enhance’ the accuracy of disease staging compared to traditional anatomical imaging, UCLA noted.

Researchers conducted a retrospective study using data from 182 subjects with high-risk recurrent prostate cancers who were eligible for the EMBARK trial, which used conventional imaging for classification.

In this trial, it has been demonstrated that adding enzalutamide to androgen deprivation therapy improves metastasis-free survival. Nonetheless, the trial’s reliance on conventional imaging may have underestimated the disease’s extent.

The UCLA study found that PSMA-PET detected cancer metastases in 46% of subjects, with 24% having five or more lesions missed by conventional imaging.

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These findings claim to ‘challenge’ earlier studies’ interpretations and advocate for the inclusion of PSMA-PET in subject selection for future clinical trials. The study also suggests a need to ‘reevaluate’ treatment strategies, potentially offering ‘curative’ options like targeted radiotherapy for some individuals.

UCLA David Geffen School of Medicine’s molecular and medical pharmacology associate professor and Ahmanson Translational Theranostics Division clinical research programme director Dr Jeremie Calais said: “Our study demonstrates the critical role of PSMA-PET in accurately staging prostate cancer, which can significantly impact treatment decisions and outcomes.”

Further research is ongoing to understand the impact of PSMA-PET on long-term outcomes and its role in guiding therapy.

UCLA is ‘analysing’ follow-up data from four trials to evaluate treatment decisions and results influenced by PSMA-PET. In addition, an international consortium is studying the prognostic value of PSMA-PET in more than 6,000 subjects.