PSMA PET-CT May Avoid Prostate Biopsy in Men Over 80
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Prostate cancer is the most common cancer in men. Among every 100 men over 80, 30 have prostate cancer. Screening older men can help detect disease earlier and improve treatment outcomes.
Traditional screening includes a prostate-specific antigen (PSA) blood test, transrectal ultrasonography (TRUS) and prostate biopsy. PSA can help estimate risk, but TRUS and biopsy are not always reliable for an accurate diagnosis.
PSMA PET/CT imaging is a new technology for more accurate prostate cancer diagnosis. PSMA is a protein present at high levels in prostate cancer cells. PSMA PET/CT detects disease using a radioactive substance that binds to it.
Research suggests that PSMA PET/CT can detect prostate cancer in older men without a pre-imaging biopsy, offering a less invasive and lower-risk screening method.
“Pre-imaging biopsy” or “image-guided prostate biopsy” is used in prostate cancer screening. A small tissue sample is removed from the prostate and examined microscopically. This is highly effective diagnostically but invasive and risky. Below, the shorter term “prostate biopsy” will be used.
Research Methods and Results
The Journal of Nuclear Medicine published a study in July 2023 in which researchers enrolled men aged 80 and older: 100 patients undergoing staging with Ga-68-PSMA-11 PET/CT. They documented whether biopsies had been performed, clinical characteristics, PET staging parameters and primary treatment.
Researchers found that 34% had not undergone prostate biopsy. These patients tended to be older, in poorer clinical condition and have higher PSA levels than those biopsied. All non-biopsied patients had avid disease on Ga-68-PSMA-11 PET/CT and tended to have more bone metastases and advanced disease overall.
Avid disease binds strongly to the radioactive substance. In other words, cancer cells take up more of it, improving their detection on PSMA PET/CT.
Similar proportions of biopsied and non-biopsied patients were referred for hormonal therapy. However, 63% of biopsied patients were referred for radiotherapy after imaging, compared with only 8.8% of those without biopsy.
These findings suggest that PSMA PET/CT can detect prostate cancer in older men without prostate biopsy, potentially supporting earlier diagnosis and better treatment outcomes.
The study’s graphical abstract appears below:
Overview
- Prostate cancer is the most common cancer in men.
- Screening older men can support early diagnosis and better treatment outcomes.
- PSMA PET/CT is a new technology for more accurate prostate cancer diagnosis.
- It can detect prostate cancer in older men without prostate biopsy for screening.
- The technology may help diagnose prostate cancer earlier in older men and improve treatment outcomes.
Sources
Journal of Nuclear Medicine July 2023, 64 (7) 1030-1035; DOI: https://doi.org/10.2967/jnumed.122.265371
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