Key clinical point: Frontline imaging with gallium-68 prostate-specific membrane antigen (PSMA)-11 positron emission tomography-computed tomography (PET-CT) shows superior accuracy, specificity, and sensitivity vs. conventional imaging with CT and bone scan in patients with high-risk prostate cancer.

Major finding: PSMA PET-CT showed a 27% greater accuracy compared with conventional imaging (92% vs. 65%; P less than .0001). Conventional imaging vs. PSMA PET-CT had a lower sensitivity (38% vs. 85%) and specificity (91% vs. 98%).

Study details: In this phase 3 study, 302 high-risk patients with prostate cancer undergoing radical treatment were randomly assigned to conventional CT and bone scanning or PSMA PET-CT.

Disclosures: This study was funded by the Movember and Prostate Cancer Foundation of Australia. The presenting author reported receiving grants from the Prostate Cancer Foundation of Australia, Movember, and the Peter MacCallum Foundation, during the conduct of the study.

Commentary

“Accurate determination of the extent of the spread of prostate cancer is critical to optimizing treatment. CT and bone scanning have been the standard imaging modalities for several years, but insufficient sensitivity and specificity for the identification of metastatic disease has been a concern. Prostate-specific membrane antigen (PSMA) PET-CT has been increasingly studied as a diagnostic tool that may be more accurate than bone scanning and CT.

In the proPSMA study, men with high risk prostate cancer were randomized to CT and bone scanning vs. PSMA PET-CT imaging. PSMA PET-CT was found to have greater accuracy, sensitivity, and specificity than conventional imaging, and management changes in treatment were made more frequently in the group randomized to PSMA PET-CT. PSMA PET-CT is likely to replace CT and bone scanning in the diagnostic workup of men with prostate cancer over the next several years as the technology is adopted more widely.”

Mark Klein, MD