PSMA PET/CT Can Reveal Prostate Cancer Diagnosis in Elderly Patients

PSMA PET/CT scans can detect signs of prostate cancer in elderly patients without the need of a biopsy, diagnose advanced disease and assist in determining which therapy will be most promising for each patient, according to study findings published in July in The Journal of Nuclear Medicine.

This new scan, researchers found, can possibly decrease the amount of prostate biopsies and subsequent complications for elderly patients with prostate cancer as well.

PSMA PET/CT is an imaging process which reveals prostate cancer within the body and is known to be extremely sensitive and specific. The scan is generally indicated for patients for whom intermediate or high-risk cancer has already been confirmed via biopsy — but, when it comes to elderly patients, undergoing a prostate biopsy may include longer hospital stays and higher risk of complications post-biopsy, according to a press release from the Society of Nuclear Medicine and Molecular Imaging.

“Due to the risks of biopsy for elderly patients, they are occasionally referred for PSMA PET/CT without a pre-imaging-confirming biopsy. In our study we sought to determine the rate, clinical characteristics and PET-based stage of elderly patients referred for PSMA PET/CT without biopsy and explore whether their biopsy status affected therapeutic approach,” explained Dr. Einat Even-Sapir, head of the department of nuclear medicine at Tel Aviv Sourasky Medical Center and professor of imaging at Tel Aviv University in Tel Aviv, Israel, in the press release.

The study consisted of 100 patients who were at least 80 years old and who used the PSMA PET/CT scan. The study evaluated if pre-imaging biopsy was occurring, clinical characteristics, staging parameters from the scan and therapy that took place, according to the press release.

The study found that 34% of patients did not receive pre-imaging biopsies. Patients without pre-imaging biopsy were older, revealed worse clinical status and showed signs of high levels of prostate-specific antigen (PSA, a protein expressed by prostate cells, higher levels of which are often found in patients with prostate cancer). Alongside this, these patients were shown to have avid disease and showed signs of elevate risk of bone metastases and advanced disease, according to the press release.

Researchers found that the percentage of patients with biopsy who were referred to radiotherapy after imaging was 63%, in comparison to 8.8% of patients who didn’t have pre-imaging.

“The results of the current study indicate that 100% of the elderly patients who were referred for PSMA PET/CT on the basis of clinical suspicion only were found to have avid disease. Given that positive PSMA PET/CT results usually indicate clinically significant rather than clinically insignificant prostate cancer, and together with the insignificant negative effect of radiation exposure in elderly patients, the practice of waiving the need for pre-imaging biopsy when the clinical suspicion is high proves to be effective and to have no apparent negative cost,” explained Even-Sapir.

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