proPSMA: PSMA PET-CT versus conventional imaging for staging high-risk prostate cancer
PSMA PET-CT was 27 percentage points more accurate than CT and bone scan for finding spread in men with high-risk prostate cancer before treatment, with less radiation and more influence on management, and it has replaced conventional imaging where available.
Overview
Randomised multicentre trial of 302 men with high-risk localised prostate cancer randomised to conventional imaging (CT and bone scan) or gallium-68 PSMA PET-CT for staging, with crossover imaging to define a reference standard.
Accuracy was 92 percent for PSMA PET-CT against 65 percent for conventional imaging, with higher sensitivity (85 versus 38 percent) and specificity, fewer equivocal results, lower radiation dose and more frequent management change.
- Accuracy 92 percent vs 65 percent (27 percent absolute difference).
- Sensitivity 85 percent vs 38 percent; specificity 98 percent vs 91 percent.
PSMA PET-CT is the preferred staging investigation for high-risk prostate cancer and for biochemical recurrence, though most treatment trials were designed with conventional imaging.
- Reference standard relied partly on imaging follow-up rather than histology.
- Detecting more disease does not by itself prove better outcomes.
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