Real-world experience of 18F-PSMA-1007 PET-CT scanning for initial staging of high-risk non-metastatic prostate cancer: scan results and treatment decisions

Staffurth, John ORCID: https://orcid.org/0000-0002-7834-3172, Mukherjee, Saptarshi, Fielding, Patrick, Renninson, Emily and Rees, John I. 2025. Real-world experience of 18F-PSMA-1007 PET-CT scanning for initial staging of high-risk non-metastatic prostate cancer: scan results and treatment decisions. Clinical Oncology , 103900. 10.1016/j.clon.2025.103900 Item availability restricted.

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Abstract

Recent literature has shown the higher accuracy of staging PSMA-PET scans over conventional imaging for high-risk localised prostate cancer patients suitable for radical treatment. All-Wales guidelines recommended PSMA-PET scans prior to radical therapy in 2020. We have studied the outcome of high-risk prostate cancer patients referred for a staging PSMA-PET CT scan in Cardiff to identify the proportion for nodal or distant metastases, the association between risk factors and PET positivity, how treatment varied by PET result and the outcome of men undergoing surgery. 200 men underwent staging PSMA PET scans, of whom 143 had no evidence or suspicion of nodal or distant metastases on conventional imaging. Of these 143 patients, 102 (71%), 25 (17.5%) and 16 (11.2%) had post-PET staging of TxN0M0 (PETN0M0), TxN1M0 (PETN1M0) and TxNxM1 (PETM1), respectively. The risk of harbouring microscopic nodal or distant metastases was 12%, 38% and 72% for men with 1, 2 or 3 high-risk factors, respectively. The risk also increased as the extent of each risk factor increased. The nodal false negative rate for the 22 men with PETN0M0 disease undergoing prostatectomy was 9.1% despite the median number of nodes identified being only 8. Considering the entire 200 patient cohort, the treatment was strongly influenced by PET results: 56% of PETN0M0 men had radical treatment to the prostate and 37% to prostate + nodes, 87% of PETN1M0 men had prostate and pelvic nodal radiotherapy with long-course androgen deprivation therapy (ADT) +/- androgen receptor pathway inhibitor (ARPI) whereas 95% of men with PETM1 disease had permanent ADT therapy +/- radiotherapy +/- ARPI. Our results reflect international literature and strongly support the role of staging PSMA-PET scans prior to radical therapy in all high-risk prostate cancer patients. Extension to unfavourable intermediate-risk should be considered.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine
Publisher:	Elsevier
ISSN:	0936-6555
Date of First Compliant Deposit:	8 July 2025
Date of Acceptance:	25 June 2025
Last Modified:	08 Jul 2025 11:45
URI:	https://orca.cardiff.ac.uk/id/eprint/179592

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