The impact of PSMA-PET/CT on clinical decision-making in primary staging of prostate cancer
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background : Accurate staging is essential for optimal management of prostate cancer. Conventional imaging with computed tomography and bone scintigraphy has limited sensitivity and specificity, particularly for small-volume disease. Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) has emerged as a more sensitive modality, but its impact on clinical decision-making in primary staging remains to be fully defined. In this retrospective single-center study, we evaluated the impact of PSMA-PET/CT on treatment strategies compared with conventional imaging in patients with intermediate- and high-risk prostate cancer at Skåne University Hospital, Sweden, between October 2020 and December 2022. All patients underwent [ 18 F]PSMA-1007 PET/CT, computed tomography and bone scintigraphy within 90 days. Management decisions were assessed by comparing treatment decisions based on conventional imaging alone with those incorporating PSMA-PET/CT findings, and were classified as major (shift between curative and non-curative treatment intent), medium (modification of surgical or radiotherapy plans without altering overall treatment intent), and mino r (additional investigations or minor adjustments resulting in treatment delay without change of intent or modality). Results: A total of 287 consecutive patients were included, of whom 59 (21%) had intermediate-risk and 228 (79%) high-risk disease. Overall, 187 patients (65%) had negative findings on all imaging modalities, while 100 (35%) had positive findings. PSMA-PET/CT identified lesions in 94 patients, whereas only 6 patients had positive findings exclusively on conventional imaging. PSMA-PET/CT led to a change in clinical management in 65 patients (22.6%), including major changes in 31 (10.8%), medium changes in 28 (9.9%), and minor changes in 6 (2.1%). Among patients with positive PSMA-PET/CT findings (n=94), 32.0% experienced major, 29.8% medium and 5.2% minor treatment modifications. Management changes were more frequent in high-risk patients (24.6%) compared to intermediate-risk patients (15.3%). Conclusion: PSMA-PET/CT provides actionable information that leads to changes in clinical management in approximately one in four patients undergoing primary staging of prostate cancer, with the greatest impact observed in high-risk disease. These findings support the integration of PSMA-PET/CT into routine staging to enable more precise and individualized treatment planning.
Source: EJNMMI Research
Institutions: Lund University, Skåne University Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,190
Awards: G1960764132, G3072152110
OpenAlex ID: W7166682510