PSMA PET/CT improves outcomes for men with recurrent prostate cancer

A new study from Denmark shows for the first time that men with biochemically recurrent prostate cancer who undergo PSMA PET/CT before salvage radiotherapy have improved survival rates compared to those who do not.

Using data collected nationwide over a period of eight years, researchers confirmed that PSMA PET/CT is a valuable tool for identifying patients who are likely to benefit from salvage radiotherapy. This research was published in the August issue of The Journal of Nuclear Medicine.

Biochemical recurrence after radical prostatectomy occurs in up to 40 percent of prostate cancer patients and salvage radiotherapy is recommended as the main curative option. With salvage radiotherapy, physicians rely on imaging to precisely locate recurrences for targeted treatment. While this imaging was previously performed with bone scintigraphy, CT, or MRI, the excellent diagnostic capability of PSMA PET/CT makes it the current modality of choice.

It is widely accepted that PSMA PET/CT is more accurate than other imaging methods for returning prostate cancer, and that it often changes patient treatment strategies, said Anna W. Mogensen, MSc, a PhD student at the Department of Nuclear Medicine at Aalborg University Hospital in Aalborg, Denmark. Nevertheless, it has remained unclear whether PSMA PET/CT guided changes in treatment strategy led to improved survival.

She continued, PSMA PET/CT was introduced in Denmark in 2015; however not all regions adopted the imaging modality at once. Utilizing Denmark s nationwide health registry, my colleagues and I compiled a large and comprehensive dataset to compare the overall survival between patients who underwent PSMA PET/CT before salvage radiotherapy and those who did not.

The study used data obtained from routine clinical practice of all patients treated with salvage radiotherapy in Denmark from 2015 through 2023. In total, 844 patients were categorized according to whether they underwent pretreatment PSMA PET/CT (308 patients) or did not (536 patients). Researchers compared the overall survival, as well as biochemical recurrence-free survival, for up to five years after completion of salvage radiotherapy. 

The analysis revealed greater overall survival for patients who underwent PSMA PET/CT before salvage radiotherapy than for patients who did not. The one-, two-, and five-year survival rates for PSMA PET/CT patients were 100, 99.5, and 98.1 percent, respectively, versus 99, 97.8, and 93.8 percent, respectively, for non-PSMA PET/CT patients.

The three-year biochemical recurrence-free survival rate was consistent with overall survival: 74.9 percent for PSMA PET/CT patients and 69.4 percent for non-PSMA PET/CT patients.

Our findings show that PSMA PET/CT scans can help clinicians select the patients most likely to experience success with salvage radiotherapy. This means fewer patients may receive unnecessary treatment, while more will be provided with the appropriate care, Mogensen said. These findings support broader use of nuclear medicine techniques to guide therapy and suggest that integrating imaging early in treatment decisions could become a new standard in cancer care.