For which patients?

The following overview shows when PSMA PET-CT can be chosen for prostate cancer and also which studies can be used as an alternative .

PSMA PET-CT in primary diagnosed prostate cancer

When treating cancer, it is always important to know whether there is a risk that the cancer has spread. If that risk is present, further research will be required to answer this question. In prostate carcinoma, a PET-CT scan with Fluor-PSMA or Gallium-PSMA can give an indicative answer to whether the disease has spread. This study will be used with people with an average to high risk profile (see table 1). If there is an average to high risk of bone metastases, a Tc-99m bone scan or F-18 NaF PET-CT may also be performed to detect bone metastases. F-18-FDG PET-CT can also be chosen for poorly differentiated or aggressive prostate carcinomas, for example with Gleason ≥8.

PSMA PET-CT in recurrent prostate cancer

If the PSA rises or remains high after a curative treatment for prostate cancer has taken place, it is important to quickly locate where currently active prostate cancer cells are. This ensures that a localized treatment may still be used, such as radiotherapy which can be aimed at the metastases or the local recurrence in the prostate bed. In this case, you can opt for a PET-CT scan again with either Fluor-PSMA or Gallium-PSMA. In the case that a hospital cannot perform PSMA scans, F-18-choline PET-CT can also be chosen.

PSMA PET-CT in therapy response monitoring

An accurate way to monitor disease activity under therapy is to make a PSMA PET-CT scan as a baseline, and to assess the disease burden again using PSMA PET-CT in a follow-up scan. If scanning was initially performed with Fluor-PSMA or Gallium-PSMA, it is preferable to also perform the follow-up with Fluor-PSMA and Gallium-PSMA respectively. If the baseline scan provides a good representation of the disease, the follow-up scan should be done in the same way.

Table 1