Patterns of primary staging for newly diagnosed prostate cancer in the era of prostate specific membrane antigen positron emission tomography: A population‐based analysis

Abstract

Introduction: There has been a growing body of evidence highlighting the improved sensitivity and specificity for prostate specific membrane antigen (PSMA) positron emission tomography (PET) in advanced prostate cancer imaging. We aimed to assess prostate cancer staging practice patterns in Australia using population-based data. Subject and Methods: We extracted data on men diagnosed with prostate cancer between October 2016 and December 2018 from the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic). We evaluated trends and comparisons between patients receiving PET/CT (with or without conventional imaging (CImg)), and CImg alone, and analysed imaging modality as predictor of clinical regional node positive disease (cN1 vs cN0/X), metastatic disease (cM1 vs cM0/X), and treatment received. Results: In total, 6139 patients in the registry had either a staging PET scan (n = 889, 14%), CImg without PET scan (n = 2464, 40%), or no recorded PET or CImg (n = 2786, 45%). The proportion of allimaged patients who received staging PET increased from 19% to 36% from the first to last three-month period, and in the high-risk category the increase was 23-43%. After adjustment for grade group, PET vs CImg-only patients were observed to have a higher proportion of cN1 disease (OR = 2.46, 95% CI: 1.90-3.20) but not cM1 disease (OR = 1.10, 95% CI: 0.84-1.44). Conclusions: Our registry data highlights the rapid uptake of PET imaging, particularly in high-risk disease. Based on this data, we highlight the increased diagnosis of nodal disease, thus potentially optimizing patient selection prior to definitive treatment for prostate cancer.

Early results of PRO-EPI: PROspective multicenter observational study on elective pelvic nodes irradiation in patients with intermediate/high/very high-risk non-metastatic prostate cancer submitted to radical, adjuvant, or salvage radiotherapy with or without concomitant androgen deprivation therapy

“…Remarkably, the adoption of prostate-specific membrane antigen PET/CT (PSMA-PET/CT) is rapidly expanding due to its ability to detect nodal disease earlier than conventional imaging and at relatively lower levels of PSA ( 36 , 37 ).…”

“…Although, currently, PSMA-PET/CT is mostly used for re-staging the disease after biochemical recurrence ( 37 , 38 ), its integration in frontline staging at first diagnosis for IHR-nmPca could provide information not detectable with conventional imaging in a large fraction of patients, which might change the management in about a third of the cases ( 39 ).…”

The prognostic value of lymph node staging with prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node‐positive patients with prostate cancer

“…With prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/ CT as an emerging imaging technique [17], enhanced visualization of metastatic disease is obtained [18,19]. PSMA PET/CT imaging is able to improve the early preoperative detection of lymph node metastatic disease in the surgical template of ePLND compared with conventional imaging techniques [18,20].…”

Social determinants of health: does socioeconomic status affect access to staging imaging for men with prostate cancer

“…However, it is likely that access to key diagnostic modalities are implicated. In prostate cancer, significant advances to radiologic staging have occurred following the introduction of multiparametric magnetic resonance imaging (MRI) [5] and positron emission tomography (PET) [6,7]. We aimed to assess the impact of SDOH on access to novel imaging modalities in prostate cancer.…”