Can PSMA PET/CT Improve Prostate Cancer Staging and Care?

TOPLINE:

A Danish study found that replacing the conventional fluorine-18 sodium fluoride (¹⁸F-NaF) PET/CT (“NaF” scan for short) with fluorine-18 prostate-specific membrane antigen-1007 (¹⁸F-PSMA) PET/CT (“PSMA” scan for short) for the staging of high-risk prostate cancer resulted in significant metastatic stage migration and the alteration of treatment plans in a significant number of patients, thereby boosting care.

METHODOLOGY:

• Researchers in Denmark conducted a prospective single-centre study including 160 patients with newly diagnosed high-risk prostate cancer between 2021 and 2024.
• All the participants first underwent an NaF scan, followed by a PSMA scan within 3 weeks; initial staging and treatment decisions were made only on the basis of NaF scan and CT results.
• PSMA scan findings were then revealed, and multidisciplinary teams reassessed the metastatic stage and revised tentative treatment plans.
• Outcomes were the reclassification of the metastatic stage and the resulting change in treatment intent, for example, a shift from curative to non-curative.

TAKEAWAY:

• Stage reclassification occurred in 25% of patients after the PSMA scan, with 24% classified as having a more advanced stage (P <.001), primarily due to an increased detection of lymph node metastases.
• The rate of extrapelvic lymph node metastases increased significantly from 16% on the NaF CT scan to 27% on the PSMA scan. A total of 19% of patients showing no nodal involvement on CT were found to have nodal disease on the PSMA scan.
• Treatment plans were modified for 13% of patients (on the basis of the findings of the PSMA scan), with 12% of patients requiring more advanced-stage disease management (P=.001), reflecting a shift from curative to non-curative intent or towards more intensified systemic therapy.
• Among 69 patients initially considered for curative treatment, 12% of patients were reassigned to receive non-curative therapy.

IN PRACTICE:

“The use of ¹⁸F-PSMA PET/CT resulted in significant metastatic stage migration and influenced treatment planning in a substantial proportion of patients,” the authors wrote. “These findings illustrate the potential consequences of implementing a shift in daily clinical practice from conventional imaging modalities to the more sensitive ¹⁸F-PSMA PET/CT,” they added.

SOURCE:

This study was led by Claus Madsen, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark. It was published online on October 09, 2025, in The Journal of Nuclear Medicine.

LIMITATIONS:

The results of the NaF scan and initial clinical treatment decisions were known to the project multidisciplinary team, which may have introduced bias into the PSMA-based treatment reassessment.

DISCLOSURES:

No funding information was provided for this study, and the authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.