A study led by UCLA Health’s Jonsson Comprehensive Cancer Center published in JAMA Network Open found that nearly half of patients classified as non-metastatic using traditional imaging were found to have metastatic disease when evaluated with advanced PSMA-PET (prostate-specific membrane antigen emission tomography) imaging, highlighting the limitations of traditional imaging in accurately assessing the spread of cancer.
Research has shown that high-risk non-metastatic hormone-sensitive prostate cancer is more aggressive than previously thought.
Our study demonstrates the important role of PSMA-PET in accurately staging prostate cancer, which may have a significant impact on treatment decisions and outcomes .
Jeremy Curry, PhD, senior study author and associate professor at the David Geffen School of Medicine at the University of California, Los Angeles
Callais also serves as research director for the Clinical Research Program in Ahmanson’s Translational Diagnostics and Therapeutics Division.
This advanced imaging technology is significantly redefining how prostate cancer is classified. PSMA-PET imaging uses small amounts of a radioactive “tracer,” or radioactive tracer.
These markers attach to prostate cancer cells and are visible during PET scans. Unlike traditional imaging that only provides anatomical details, PSMA-PET provides functional imaging that shows the biological activity of the cancer, which can greatly improve the accuracy of disease classification.
Although the clinical application of PSMA-PET has revolutionized prostate cancer imaging, clinical trials have not used this advanced imaging modality to select patients for routine treatment decisions.
The researchers conducted a retrospective cross-sectional study to better understand the benefits of PSMA-PET compared with conventional imaging, using data from 182 high-risk men with recurrent prostate cancer who were considered to have disease confined to the prostate and were included in the EMBARK trial.
This earlier clinical trial showed that combining androgen deprivation therapy with enzalutamide, a type of hormone therapy, significantly improved metastasis-free survival, but that study used traditional imaging techniques to stratify patients, which may have underestimated the severity of the disease in some cases, the researchers said.
While conventional imaging showed no evidence of cancer spread, the researchers found that PSMA-PET identified cancer spread in 46 percent of patients, and PSMA-PET identified five or more lesions that were missed by conventional imaging in 24 percent of patients.
Although it is expected that PSMA-PET will detect more suspicious findings than conventional imaging, it has been challenging to find numerous metastatic findings in a well-defined patient population, such as the EMBARK trial population, which was meant to include only patients without metastases .
Adrian Holtzgrave, PhD, visiting assistant professor at the David Geffen School of Medicine at the University of California, Los Angeles, and first study author
These findings call into question the conclusions of previous studies such as the EMBARK trial and support the incorporation of PSMA-PET into the patient selection process for future large industry-sponsored clinical and interventional trials in prostate cancer.
The report raises important questions about the implementation of new imaging technologies into routine care and also highlights the need to reevaluate treatment approaches and offer potentially curative options, such as targeted radiation therapy, to some patients.
While the current results highlight the potential of PSMA-PET, more research is needed before broader applications can be considered. Carré notes that more research is needed to fully understand how it might affect long-term patient outcomes and how that might translate to the most effective treatments.
There is good reason to believe that relying primarily on PSMA-PET findings may be useful, but better quality prospective data are needed to confirm the superiority of PSMA-PET in guiding treatment in terms of patient outcomes. However, we believe that PSMA-PET will continue to advance prostate cancer staging and guide personalized treatment .
Adrian Holtzgrave, PhD, visiting assistant professor at the David Geffen School of Medicine at the University of California, Los Angeles, and first study author
UCLA researchers are currently analyzing follow-up data from four UCLA trials to evaluate how PSMA-PET findings impact treatment decisions and patient outcomes. As part of an international research group studying more than 6,000 patients, the research team is investigating the prognostic significance of PSMA-PET.
Journal References:
Holzgreve, A., et al . (2025) PSMA-PET/CT findings in high-risk biochemically recurrent prostate cancer patients without metastatic disease on conventional imaging. JAMA Network Open . doi.org/10.1001/jamanetworkopen.2024.52971.
sauce:
University of California, Los Angeles
