The Cancer Detective: PSMA-PET Uncovers What Scans Overlook in Prostate Cases
- hkmmkeung
- 1 day ago
- 5 min read
Commentary by Dr. Donald Greig
As we continue our Movember series on men's health, building on last week's discussion of prostate cancer screening complexities, it's exciting to spotlight a game-changing advancement in diagnostics. Researchers at UCLA Health's Jonsson Comprehensive Cancer Centre have just published findings in JAMA Network Open (3 January 2025) that could redefine how we detect and treat high-risk prostate cancer. Their study shows that nearly half of patients thought to have non-metastatic disease—based on standard scans—actually have hidden metastases uncovered by a cutting-edge tool called PSMA-PET imaging. This isn't just a tech upgrade; it's a wake-up call for more precise care. 🔬💡
What Is PSMA-PET and Why Does It Matter?
Traditional imaging, like CT or bone scans, focuses on the body's structure to spot tumours. But PSMA-PET (prostate-specific membrane antigen positron emission tomography) goes deeper. It uses a tiny dose of radioactive tracers that latch onto prostate cancer cells, lighting them up on scans to reveal not just where the cancer is, but how active it is biologically. For men with high-risk, hormone-sensitive prostate cancer, this means catching spread to bones, lymph nodes, or elsewhere that conventional methods miss—up to 46% of cases in the study!
The research looked back at 182 patients from the EMBARK clinical trial, who were selected because standard imaging showed cancer confined to the prostate. Yet PSMA-PET flipped the script: It detected metastases in nearly half, including 24% with five or more lesions previously invisible. As lead author Dr. Adrien Holzgreve noted, "We knew PSMA-PET would find more, but seeing this in a group meant to be nonmetastatic was eye-opening." Senior author Dr. Jeremie Calais added that this accuracy "significantly impacts treatment decisions and outcomes," potentially shifting from aggressive whole-body therapies to targeted ones like radiotherapy on specific spots. 🎯
Shaking Up Treatment and Trials
This discovery challenges past studies like EMBARK, which proved that adding enzalutamide (a hormone therapy) to standard androgen deprivation therapy boosts metastasis-free survival. But those trials used outdated imaging for patient selection, possibly including some with undetected spread. Now, experts are calling for PSMA-PET to become standard in future trials and care, helping tailor therapies to a man's true disease stage. For some, it might open doors to curative options; for others, it avoids overtreatment.
UCLA's ongoing work—including data from four trials and an international study of over 6,000 patients—will track how these insights affect long-term survival and personalized plans. While more prospective research is needed to confirm PSMA-PET's edge in guiding outcomes, the team is optimistic: "We're confident it will advance staging and therapies," says Holzgreve.
What Does This Mean for You?
If you're a man over 50, high-risk (family history, Black ethnicity, or BRCA mutations), or already diagnosed, this underscores why discussing advanced imaging with your GP or oncologist is crucial. Early, accurate staging can mean better survival odds and fewer side effects from unnecessary treatments. Prostate cancer often hides in plain sight—tools like PSMA-PET are bringing it into the light, empowering informed choices. Remember our screening chat? This builds on that: Know your risks, watch for symptoms (like bone pain or urinary issues), and advocate for the latest diagnostics. 💪
This Movember, let's champion innovations that save lives without excess harm. Have you talked to your doctor about imaging options? Share your thoughts below—knowledge shared is health gained.
Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.
The Cancer Test That Exposes What Conventional Scans Miss
Article by University of California
Researchers at UCLA have unveiled startling findings using PSMA-PET imaging that reveal nearly half of patients diagnosed with high-risk prostate cancer might actually have metastases missed by traditional imaging methods. Breakthroughs in Prostate Cancer Imaging Researchers at UCLA Health’s Jonsson Comprehensive Cancer Center have discovered that many cases of high-risk, hormone-sensitive prostate cancer classified as nonmetastatic may actually be more advanced than originally believed. The study, published today (January 3) in JAMA Network Open, revealed that nearly half of these patients, initially diagnosed as nonmetastatic using traditional imaging, were found to have metastatic disease when assessed with advanced prostate-specific membrane antigen–positron emission tomography (PSMA-PET) imaging. This suggests that conventional imaging often underestimates the extent of cancer spread. Impact of PSMA-PET on Treatment Decisions “Our study demonstrates the critical role of PSMA-PET in accurately staging prostate cancer, which can significantly impact treatment decisions and outcomes,” said senior author of the study Dr. Jeremie Calais, director of the Ahmanson Translational Theranostics Division’s clinical research program and associate professor at the department of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA. This advanced imaging technology plays a critical role in redefining how prostate cancer is staged. PSMA-PET imaging uses tiny amounts of radioactive “tracers,” called radiotracers, that binds to prostate cancer cells, making them visible on PET scans. Unlike conventional imaging, which provides only anatomical details, PSMA-PET offers functional imaging that reveals the cancer’s biological activity, which can significantly improve the accuracy of disease staging. |
Changing Clinical Practices with New Imaging Techniques
The clinical adoption of PSMA-PET has changed the landscape of prostate cancer imaging, yet treatment decisions often rely on clinical trials that did not incorporate this advanced imaging technique for patient selection.
To better understand the advantages of PSMA-PET over conventional imaging, researchers conducted a post hoc, retrospective cross-sectional study using data from 182 patients with high-risk recurrent prostate cancers who were thought to have disease limited to the prostate and were eligible for the EMBARK trial.
This clinical trial previously demonstrated that adding enzalutamide, a type of hormone therapy, to androgen deprivation therapy significantly improves metastasis-free survival. However, the trial relied on conventional imaging to classify patients, which researchers believe might have underestimated the disease’s extent in some cases.
In the cohort of patients, the researchers found PSMA-PET detected cancer metastases in 46% of patients, even though traditional imaging had suggested no evidence of cancer spread. Based on PSMA-PET, 24% of the patients even showed 5 or more lesions that had been missed by conventional imaging.
“We anticipated that PSMA-PET would detect more suspicious findings compared to conventional imaging. However, it was informative to uncover such a high number of metastatic findings in a well-defined cohort of patients resembling the EMBARK trial population that was supposed to only include those without metastases,” said Dr. Adrien Holzgreve, a visiting assistant professor at the David Geffen School of Medicine and first author of the study.
Implications for Future Research and Clinical Trials These results challenge the interpretation of previous studies, like the EMBARK trial, and support the inclusion of PSMA-PET for patient selection in clinical and trial interventions in prostate cancer in future major industry-sponsored clinical trials. It also highlights the need to reevaluate treatment strategies and opens the door to potentially curative options for some patients, such as targeted radiotherapy, while raising important questions about integrating new imaging technologies into standard care. While the current findings underscore PSMA-PET’s potential, researchers are continuing to explore its broader applications through additional studies. More research is needed to understand its impact on long-term patient outcomes and how it can best guide therapy, noted Calais. “We have good rationales to assume that it is helpful to primarily rely on PSMA-PET findings,” said Holzgreve. “But more high-quality prospective data would be needed to claim superiority of PSMA-PET for treatment-guidance in terms of patient outcome. However, we are confident PSMA-PET will continue to advance prostate cancer staging and guide personalized therapies.” Ongoing efforts at UCLA include analyzing follow-up data from four UCLA trials to assess how PSMA-PET findings influenced treatment decisions and patient outcomes. Additionally, as part of an international consortium studying over 6,000 patients, the team is investigating the prognostic value of PSMA-PET. |
Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.