Dr Koo on the Clinical Utility of PSMA PET in Prostate Cancer

Phillip J. Koo, MD, chief, Diagnostic Imaging, Banner MD Anderson Cancer Center, discusses the clinical use of prostate-specific membrane antigen (PSMA) PET imaging in patients with prostate cancer, highlighting ongoing research that is further investigating the use of this imaging.

Numerous clinical trials are now integrating PSMA PET into their protocols, marking a significant advancement in the treatment of patients with prostate cancer, Koo begins. The wealth of data being accumulated in this field promises to shed light on the impact of PSMA PET and its role in guiding treatment decisions, Koo adds. In the context of biochemical recurrence, pivotal studies, such as the phase 2 ORIOLE (NCT02680587), SABR-COMET (NCT01446744), and STOMP (NCT01558427) trials, have provided valuable insights into optimizing the use of PSMA PET to inform the application of metastasis-directed therapy (MDT), he reports. However, debate persists as to whether the available data warrant the widespread adoption of MDT in these cases, and varying perspectives prevail, he notes.

The phase 3 EMBARK trial (NCT02319837), which enrolled its first patient inapproximately 2015, holds significance as well, Koo continues. EMBARK stratified patients based on whether they had a high risk or low risk of biochemical recurrence, which was particularly meaningful, as those with high-risk profiles likely exhibit more aggressive biological behavior, he adds. Consequently, tailoring disease management strategies based on risk stratification is imperative, Koo elucidates, saying that although PSMA PET was not used in EMBARK, incorporating this imaging strategy introduces complexities in patient treatment.

The absence of definitive answers regarding the optimal role of PSMA PET in prostate cancer underscores the necessity for multidisciplinary discussions to dissect these findings, he continues. Moreover, ongoing efforts to design trials integrating PSMA PET seek to address lingering questions and ascertain the most appropriate treatment approach for patients, Koo adds. This collective endeavor reflects the evolution of clinical practice, driven by a commitment to optimizing patient care through informed decision-making and collaborative exploration of emerging technologies and data, he concludes.