Clinical Use of PSMA PET in Advanced Prostate Cancer

This episode, titled ‘Clinical Use of PSMA PET in Advanced Prostate Cancer,’ features Dr. Neal Shore highlighting the differences between clinical trial data and real-world experience with PSMA PET imaging in advanced prostate cancer. While academic and international studies have reported high sensitivity and accuracy, particularly at low prostate-specific antigen (PSA) levels, clinicians in community practice settings report greater variability in both image interpretation and reporting. Inter-observer variability among readers and inconsistencies in report quality can impact how findings are understood and applied in treatment decisions.

The discussion also emphasizes that the strongest evidence for PSMA PET use remains in high-risk, newly diagnosed patients and those with biochemical recurrence following local therapy. However, real-world experience suggests that detection rates at very low PSA levels may not always match those reported in clinical studies, leading some clinicians to adopt higher PSA thresholds before ordering imaging. Additionally, the use of complementary imaging modalities, such as fluorodeoxyglucose (FDG) PET, is explored, though access and cost may limit their routine use in certain regions.

Despite these challenges, PSMA PET is widely viewed as a major advancement in prostate cancer imaging and is increasingly incorporated into routine clinical practice across disease states, including castration-resistant settings. Clinicians continue to rely on conventional imaging in parallel, particularly in research settings where historical endpoints require it. Ongoing clinical trials are working to integrate advanced and conventional imaging modalities, reflecting a transitional period in prostate cancer management. Overall, this segment underscores both the promise of PSMA PET and the need for continued refinement in its real-world application.

In the next episode, ‘Comparative PSMA PET Tracer Performance in Advanced Prostate Cancer,’ Dr. Neal Shore reviews phase 4 comparative data showing differences in urinary radioactivity and detection rates among PSMA PET tracers. These findings may influence tracer selection and improve detection of recurrent disease in advanced prostate cancer.