Molecular Imaging in Focus: A Closer Look at the Merits of PSMA PET in Staging Patients with Osseous Oligometastatic PCa

In one of the more striking abstracts presented at the recent Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference, researchers found that PSMA PET may offer significantly enhanced utility over MRI and CT in detecting osseous oligometastatic prostate cancer (PCa).

Lead study author Surekha Yadav, MBBS, MD, shared her insights on the research in a recent episode of the “Molecular Imaging in Focus” series.

“(Eighty percent of the bone-only oligometastatic patients were missed on the CT scan and MR. at the time of diagnostic imaging. That's a very strong argument for PSMA PET at initial staging in high-risk and very high-risk disease, which is actually already moving toward becoming standard of care,” maintained Dr. Yadav, a resident in molecular imaging and theranostics in the Department of Radiology at the University of California-San Francisco (UCSF).

“ … Finding lesions early changes treatment in nearly 100 percent of cases, and these patients have real prognostic differences from M0 disease, so I do believe, yes, earlier and more routine use of PSMA PET at initial staging, especially for high-risk and very high-risk patients, seems clinically justified by what we found.”

Dr. Yadav emphasized the impact of PSMA PET imaging upon the management of 36 patients in the study who had one to five bone lesions.

“ … Every single of these 36 patients received intensified systemic therapy as a direct result of the PSMA PET findings that they had,” said Dr. Yadav. “They wouldn't be getting this intensification if they were just staged with CT or MR alone. … PSMA PET isn't just detecting disease, it's actively changing what treatment a patient is receiving.”

(Editor’s note: For additional coverage of the recent SNMMI conference, click here.)

Dr. Yadav suggested that these findings align with results from the recently published PROTEUS study, which found improved five-year metastasis-free survival with perioperative apalutamide in patients undergoing radical prostatectomy when PSMA PET imaging was added to the study protocol.

“I think our findings and (those from the) PROTEUS (trial) are pointing in the same direction. Don't let limited visible disease lead to undertreatment,” posited Dr. Yadav.

(Editor’s note: For related content, see “SNMMI: Over 80 Percent of Patients with Osseous Oligometastatic PCa are Upstaged with PSMA PET/CT,” “PSMA PET Plays Key Role in Multinational Phase 3 Trial of Perioperative Apalutamide for PCa” and “SNMMI: Does Vaccination Enhance Pluvicto Efficacy in mCRPC?”)

Reference

1. Yadav S, Hong CM, Nwihim SO, et al. Longitudinal outcomes of PSMA PET/CT-detected oligometastases: a two-center study. Presented at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) conference, May 30-June 2, 2026, Los Angeles. Available at: https://jnm.snmjournals.org/content/67/supplement_1/262291 .