Conventional imaging may not be able to accurately assess prostate cancer patients whose disease has metastasized and spread to other parts of the body, according to research conducted by the University of California, Los Angeles. Using conventional cancer imaging, the team examined a group of prostate cancer patients previously classified as non-metastatic. When they used prostate-specific membrane antigen–positron emission tomographic/computed tomographic (PSMA-PET/CT) imaging instead of conventional imaging almost half of the people screened showed evidence of metastases.

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In a press release, senior author Jeremie Calais, associate professor in the department of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA, said, “Our study demonstrates the critical role of PSMA-PET in accurately staging prostate cancer, which can significantly impact treatment decisions and outcomes.” PSMA-PET is a relatively new imaging method that binds to prostate cancer cells in the patient’s body with small amounts of radio tracers. This imaging agent then allows these cells to be seen using PET imaging. In the United States, the first PSMA radiotracer was approved more than three years ago, making it a relatively common imaging method for prostate cancer. 182 prostate cancer patients who would have been eligible to participate in a completed Phase III study known as the EMBARK study were tested in this study, which was published in JAMA Network Open. The efficacy of enzalutamide alone or in combination with leuprolide as a treatment for high-risk prostate cancer was the subject of this study. Conventional imaging was required to rule out prostate cancer metastases in order to be eligible for the study. The researchers used PSMA-PET/CT to find that 46% of patients had at least one metastasis, and 24% had five or more. “We anticipated that PSMA-PET would detect more suspicious findings compared to conventional imaging. However, first author Adrien Holzgreve, a visiting assistant professor at the David Geffen School of Medicine, said, “It was informative to uncover such a high number of metastatic findings in a well-defined cohort of patients resembling the EMBARK trial population that was supposed to only include those without metastases.” Although PSMA-PET/CT imaging is still in its infancy, these findings concur with others that demonstrate its superiority to more conventional imaging in terms of providing accurate patient diagnostic and prognostic information.