PSMA PET/CT Imaging Can Diagnose Prostate Cancer in Elderly without Need for Biopsies

Generally, PSMA PET/CT is recommended when intermediate or high-risk cancer is detected through biopsy. However, for elderly patients, undergoing a prostate biopsy may lead to prolonged hospitalization and post-biopsy complications like infections, bleeding, or urinary issues. Now, a new study has found that PSMA PET/CT can effectively diagnose advanced disease in elderly patients suspected of having prostate cancer and also assist in choosing appropriate therapies, all without the need for a biopsy.

The study by researchers at Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) involved 100 consecutive patients aged at least 80 years who underwent 68Ga-PSMA-11 PET/CT staging. The researchers meticulously documented whether these patients had undergone pre-imaging biopsies, noted their clinical characteristics, recorded PET-based staging parameters, and documented the primary treatment selected. Of the patients involved in the study, 34% had not undergone pre-imaging biopsies. Upon comparison with patients who did undergo pre-imaging biopsies, this subset of patients was older, exhibited poorer clinical statuses, and displayed elevated PSA levels.

The outcomes of the 68Ga-PSMA-11 PET/CT scans indicated that patients without pre-imaging biopsies were shown to have avid disease, indicating a higher prevalence of bone metastases and an overall more advanced disease state. Comparable proportions of patients, both those with and without pre-imaging biopsies, were referred for hormonal therapy. In contrast, among patients who underwent biopsies, 63% were subsequently recommended for radiotherapy post-imaging. However, merely 8.8% of patients without pre-imaging biopsies were advised to pursue radiotherapy.

“The results of the current study indicate that 100 percent of the elderly patients who were referred for PSMA PET/CT on the basis of clinical suspicion only were found to have avid disease,” said Einat Even-Sapir, MD, PhD, head of the Department of Nuclear Medicine at Tel Aviv Sourasky Medical Center. “Given that positive PSMA PET/CT results usually indicate clinically significant rather than clinically insignificant prostate cancer, and together with the insignificant negative effect of radiation exposure in elderly patients, the practice of waiving the need for pre-imaging biopsy when the clinical suspicion is high proves to be effective and to have no apparent negative cost.”

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Tel Aviv Sourasky Medical Center