new study in JAMA on PSMA-PET usage as it relates to understaging in a subset of high risk patients

[ManuteBol1]

Some remarkable results in this study published yesterday in JAMA. This paper strongly suggests that patients’ high-risk nonmetastatic hormone-sensitive prostate cancers are frequently understaged by conventional imaging. The results challenge the interpretation of previous studies, such as the EMBARK trial.

Interested in folks’ comments.

jamanetwork.com/journals/ja...

[GP24]

The patients in the Embark trial were selected with CT/bone scan. The results are for patients which have no mets on CT/bone scan. Many of the included patients probably would have had mets on a PSMA PET/CT but the results are valid for the entire group of patients.

The majority of the patients with non-metastatic CRPC have mets on a PSMA PET/CT. However, they can get the drugs approved for non-metastastic CRPC based on CT/bone scan.

[Tony666]

surprise, surprise. A group of patients with psa above 1.0 after RP or 2.0 above nadir after RT were found to have a high chance of metastatic cancer by the PSMA-pet scan. I could have told you that without a scan.

[Apisdorsata]

The PSMA scan is essential for proper management of prostate cancer. My case is different than those in the study but illustrates the value of the scans: I've lived with this disease for over 9 years and have had a variety of treatments. All summer I took a wonderful treatment holiday but my PSA gradually rose from undetectable to over 3. I felt great but a PSMA scan showed a 2 cm mass in my mandible. No pain. I received a course of radiation and restarted my old companions abiraterone + prednisone. Now my PSA is undetectable. Most likely the enemy lurks somewhere within but for now is defeated once more. Next summer I hope for another holiday. Time will tell.

[GP24]

I had many PSMA PET/CTs and support this type of imaging very much and use it to get the detected mets radiated. But doctors often do not take in consideration the stage migration by the more sensitive imaging. They decide which drugs to use just as if the mets were detected with CT/bone scan.

[j-o-h-n]

To repeat myself:

I must say, those guys in their paJAMAs really know their shit...

Good Luck, Good Health and Good Humor.

j-o-h-n