ASO Author Reflections: PSMA PET in the Prostate Cancer Primary Staging Scenario-A Reliable Method with a Remarkable Decision-Making Impact.

Prostate cancer (PCa) is the second most common malignant tumor in men in Brazil and worldwide. Although positron emission tomography (PET) prostate-specific membrane antigen (PSMA) has been used for over 10 years and several studies have been published regarding its superior performance in PCa primary staging and other scenarios, the management decision is often still based on conventional imaging information. A retrospective analysis was performed in 35 patients with PCa in the primary staging scenario with conventional exams as well as with PET PSMA. The findings of our study showed changes on the staging classification and significant impact on the therapeutic choice. PET PSMA is a dependable imaging exam and has already proved its worth and superiority when compared with conventional methods to evaluate PCa patients in primary staging and biochemical relapse, in addition to other potential roles. Prospective studies are needed to assess the outcome of patients whose management was guided by PSMA.

Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System.

BACKGROUND: Prostate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice. OBJECTIVE: The aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System. METHODS: Overall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics. RESULTS: PET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature. CONCLUSIONS: PSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.