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The role of prostate-specific membrane antigen PET/computed tomography in primary staging of prostate cancer

Koschel, Samanthaa,b,c; Murphy, Declan G.b,d; Hofman, Michael S.c,e; Wong, Lih-Minga,c

doi: 10.1097/MOU.0000000000000677
CALCULATING PROSTATE CANCER RISK, AVOIDANCE OF OVERTREATMENT IN LOCALIZED PROSTATE CANCER: Edited by Matthew R. Cooperberg and Declan G. Murphy
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Purpose of review Functional imaging with PET combined with computed tomography (CT) is of emerging interest in prostate cancer (PCa). Development of prostate-specific membrane antigen (PSMA) radiolabelled ligands has thrust PET/CT into the limelight as an alternative to conventional imaging techniques, and the evidence base to support its utility in primary staging of newly diagnosed PCa is rapidly growing. This review focuses on the most recent and important publications evaluating PSMA PET/CT in primary staging of PCa.

Recent findings Three recent meta-analyses have reported 68Ga-PSMA PET/CT to demonstrate superior sensitivity and specificity for pelvic lymph node detection than conventional imaging. A recent systematic review also suggests 68Ga-PSMA PET/CT to be superior to bone scan for identifying bone metastases. However, the majority of studies are of a retrospective nature, and few provide histopathological correlation of PSMA PET/CT findings. Data from prospective studies are awaited to determine accuracy and management impact of PSMA PET/CT in primary staging.

Summary PSMA PET/CT is rapidly altering the landscape of primary staging in PCa. It appears to be superior to conventional imaging for detecting regional and distant metastasis, though caution should be applied given the lack of prospective studies assessing how significant findings should be integrated into patient management. PSMA PET/CT could potentially become the gold standard for primary staging of high-risk PCa if future prospective data can prove its validity in this space.

aDepartment of Urology, St Vincent's Hospital Melbourne, Fitzroy

bDivision of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne

cDepartment of Surgery, St Vincent's Clinical School

dSir Peter MacCallum Department of Oncology, University of Melbourne, Parkville

eMolecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Correspondence to Samantha Koschel, Department of Urology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy 3065, VIC, Australia. Tel: +61 438267610; fax: +61 9327 3200; e-mail: sgkoschel@gmail.com

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