Overview

PSMA (prostate-specific membrane antigen) is found in prostate cancer cells and has elevated expression compared to benign prostatic tissue. Gallium scans using PSMA as a tracer (ie, ⁶⁸GaPSMA-positron emission tomography [PET]/computed tomography [CT] scans) are reported to be more sensitive than conventional imaging techniques in patients with prostate cancer. Recently, a prospective multicenter study in Australia investigated how ⁶⁸Ga-PSMA PET/CT scans impact patient management decisions in a population of patients with primary or recurrent prostate cancer. A total of 431 men were assessed with and without the use of ⁶⁸Ga-PSMA PET/CT imaging to develop their management plans. The study included a mix of disease states, mostly patients being assessed for restaging/biochemical recurrence (75%) but also for primary staging of intermediate-  and high-risk disease (25%). Overall, ⁶⁸GaPSMA-PET/CT scanning led to a change in planned management in 51% of patients. For patients with biochemical failure after definitive surgery and/or radiation treatment, 62% had a change in management intent, compared with patients undergoing primary staging, where there was a 21% change in management intent. Imaging with ⁶⁸GaPSMA-PET/CT revealed unsuspected disease in the prostate bed in 27% of patients, locoregional lymph nodes in 39%, and distant metastatic disease in 16% of patients.