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Current Use of PSMA-PET Scans for Prostate Cancer


Radiology experts discuss the current knowledge and use of PSMA-PET screening among colleagues, as well as unmet needs.

Umesh Oza, MD: Do you think that PSMA-PET is already there or eventually will be the standard of care for patients with prostate cancer? And if it’s not, are we just on the horizon of it? What are your thoughts, Dr Sohi?

Jaideep S. Sohi, MD: It’s a great question. In the past year, I’ve had numerous discussions with urologists, medical, and radiation oncologists. I would say the consensus statement is that we’re almost there. We’re almost there because I’m very encouraged to see that our colleagues in urology and radiation oncology have embraced PSMA-PET imaging. We’re seeing a lot more utilization of this modality. We’re still seeing some sites that are doing CT and bone scan. It’s a habit. It’s a process that has been in place for many years, and you cannot expect that practice to change as quickly as we’d like.

There’s a practical matter that not every site has access to a PET-CT? So, especially in rural communities, you have a CT scanner. You may have a spec machine for bone scan, but you may not have access to PET-CT. Maybe they get a mobile PET-CT coming in once a week, once a month, and they have so many patients that they cannot get everybody on the schedule. We have to look at those scenarios. But beyond that, when available, I think we’re seeing it being utilized with greater frequency. To answer your question, I think we’re almost there. I can’t say we’re here today, but I think we’re very close. What have you seen in your practice, because you obviously have extensive experience with this modality? And you’re seeing these patients with greater frequency.

Umesh Oza, MD: Absolutely. First of all I would 100% agree with you that there’s still some work to be done. But...the standard of care has been set, or societies are saying it. Nonradiology societies are saying it. But in my own practice, yeah, I think we’re still not getting these patients in front or this tracer to the patients we need.

And it’s multifactorial. I can’t get into all the details of it. But we need to get there and we need to get there soon. You mentioned mobile PETs, and so here in Texas, you know, big states, small towns everywhere, big cities as well, but our small towns should not be left behind. We have a robust, mobile PET service in our practice that we partnered with one of our oncology practices. Those mobile PETs go around and get to cover a lot of miles between days and between weeks, and try to get our scanners out there. The key is to get the tracer, then, to that scanner as well. And are we working with ready pharmacies to make sure that’s available to our patients?

I’ll give you my thoughts on this last question, and then you can add on. There’s always a question [about] unmet needs and clinical challenges. We’re both touching on it a little bit about accessibility and availability and things like that. I think one...unmet need is enough trials and data to know, what does all this mean? I’d hate for patients to be upstaged by this great modality, this great tracer, and then not be offered the same conventional treatments they were receiving before. I think our urologist oncologists are clearly aware of this. It’s not going to happen overnight, but I think with time and the more utilization of this—we’re all learning this, right? We’re all using it as best as we can and offering the best information and interpretation of these scans. But I’m sure you’re the same way—I learned from my clinical colleagues when I read their clinical note, or how they’re using our study, and how the patient responded to certain treatments, and how our PET scan [is used]. I think you and I are just going to be absorbing this new data and information. But the unmet need to me is still the information that’s all coming from this scan. How are they going to apply to our patient population? Clearly, we need our patients staged initially. But once that happens and treatment starts, and that’s where we are, because we’re just starting to roll out this tracer. As we go forward, what’s going to change about that? So those are my thoughts. Do you have anything to [say about] what you feel is maybe an unmet need, or something to look to the future before we end here, Dr Sohi?

Jaideep S. Sohi, MD: Yes, absolutely, Dr Oza. Fortunately, we have plenty of data, and growing, given the fact that this modality has been utilized in Europe and Australia for multiple years. Of course, we always are looking for more data and more up-to-date information. But the good news is that we do have some perspective here, going back several years with our European colleagues.

One of the unmet needs and clinical challenges that I see is the need to continuously educate and collaborate with our referring physicians. Make them aware.... A urologist that I was speaking with, they were not aware that this modality was actually being offered locally to their location. Awareness of this tracer in the local vicinity is important. Equally important is educating and collaborating with our colleagues, the radiologists, the nuclear medicine physicians who...may be in a practice where [they’re] doing PETs once a month, once a week.... They might be reading 2 or 3 scans per month. There’s a lot of work yet to be done in educating our peers with regard to how to read [scans] and how to clean the data from this modality. We all know about the artifacts, right? That can be an update and all that stuff. That’s still a work in progress. I think we’re making a lot of headway. But there’s still a lot of work to be done in educating our peers so they can, then, impact the patient care in a most positive way.

Umesh Oza, MD: Absolutely, I would absolutely agree with that. Well, I want to thank you very much, Dr Sohi, for your input, your insights, discussion. I always learn something when I speak to people like you. And today I definitely learned some things. So, I want to thank you, and for our audience, we hope you found this review discussion informative.

Transcript is AI-generated and edited for clarity and readability.

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