A GROUNDBREAKING study led by USA-based researchers has revealed that many cases of high-risk nonmetastatic hormone-sensitive prostate cancer may actually be more advanced than conventional imaging suggests. This research highlights the crucial role of advanced prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging in accurately staging the disease.
The study found that nearly half of patients previously classified as nonmetastatic by standard imaging had metastatic disease when evaluated with PSMA-PET. Unlike traditional imaging, which focuses on anatomical details, PSMA-PET uses radiotracers to target prostate cancer cells, offering highly detailed biological activity insights.
“Our study demonstrates the critical role of PSMA-PET in accurately staging prostate cancer, which can significantly impact treatment decisions and outcomes,” commented the study authors.
Researchers conducted a retrospective analysis of 182 high-risk recurrent prostate cancer patients eligible for the EMBARK trial, which had assessed the benefits of enzalutamide and androgen deprivation therapy based on conventional imaging. The findings showed that PSMA-PET detected metastases in 46% of cases, including instances where over five metastatic lesions were missed by traditional methods.
“This is a striking revelation,” noted the team. “PSMA-PET uncovered metastatic findings in a population assumed to have localised disease, challenging past trial results and treatment strategies.”
The study calls for integrating PSMA-PET into clinical trials and routine care to improve treatment selection and patient outcomes. Researchers are now analysing follow-up data from UCLA trials and participating in an international consortium studying over 6,000 patients to evaluate PSMA-PET’s long-term impact.
While further research is needed, these findings underline the transformative potential of PSMA-PET in prostate cancer management, offering hope for more precise therapies and improved survival rates.
Victoria Antoniou, EMJ
Reference
Holzgreve A et al. PSMA-PET/CT findings in patients with high-risk biochemically recurrent prostate cancer with no metastatic disease by conventional imaging. JAMA Netw Open. 2025;8(1):e2452971.
