Dr Liu on PSMA PET Imaging in Prostate Cancer

Jen-Jane Liu, MD, associate professor, urology, Oregon Health & Science University, discusses the benefits of using prostate-specific membrane antigen (PSMA) PET imaging in the localized disease setting for patients with prostate cancer, the differences between PSMA PET and conventional imaging, and future considerations for effectively implementing this diagnostic approach in this population.

PSMA PET imaging can help guide individualized prostate cancer treatment strategies, particularly in patients with high-risk disease, Liu says. Since the standard of care for an increasing number of patients with low-risk prostate cancer has become active surveillance, those with localized disease who are eligible for treatment are often those with high-risk disease, Liu notes. As PSMA PET imaging is more sensitive than conventional imaging, it can identify more sites of metastatic disease than conventional methods, even in patients who are initially believed to have localized disease, Liu explains.

However, using the results of PSMA PET imaging to guide treatment decisions requires caution, Liu says. Choosing treatments based on PSMA PET results does not always lead to better patient outcomes, since the available prostate cancer treatment indications are often based on findings from less accurate conventional imaging, according to Liu. For instance, although choosing to forego local therapy in a patient with metastatic disease was once an acceptable treatment decision based on conventional imaging results, the data informing this approach are not applicable when factoring in PSMA PET results, Liu explains.

Thoughtfully interpreting and implementing PSMA PET results can lead to more nuanced and accurate treatment approaches, Liu notes. For example, if a patient with prostate cancer is planned to receive radiation, but PSMA PET results show lymph node metastases, this treatment consideration may be expanded to include radiation at those metastatic sites as well, provided this amended approach does not cause too much additional toxicity, Liu concludes.