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Conventional Imaging Versus PSMA PET/CT Scanning in Prostate Cancer

A. Oliver Sartor, MD
Published Online: 5:52 PM, Thu November 7, 2019

A. Oliver Sartor, MD, professor of medicine, medical director, Tulane Cancer Center, C. E. and Bernadine Laborde Professor of Cancer Research, discusses a discrepancy found between conventional imaging and PSMA PET/CT scanning for prostate cancer. 
Following FDA approvals for apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa), further investigation was done to understand what percentage of these patients who received these agents may have PSMA PET/CT scan positivity, says Sartor. 
Utilizing patient characteristics from a trial of enzalutamide, this analysis showed that 98% of patients were PET positive, explains Sartor. Moreover, 55% of patients were classified as having metastatic disease, despite being deemed nonmetastatic by conventional imaging. 
These findings do not change the metastasis-free survival benefit demonstrated with apalutamide, enzalutamide, and darolutamide, says Sartor. The drugs were investigated using conventional imaging and showed a prostate-specific antigen doubling time of 10 months.
However, Sartor concludes, these imaging results may open the door to treatment options for patients, such as stereotactic body radiotherapy for metastatic disease, and radiotherapy or potentially surgery for localized disease.  

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