Real-World Experience and Impact of PSMA-PET in Post-Radical Prostatectomy Biochemical Recurrence: Findings From the MUSIC Collaborative

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: The optimal use of PSMAPET in biochemical recurrence (BCR) after radical prostatectomy (RP) is unknown. Patterns in usage and the potential management insights provided by real-world imaging results are not well described. We explore these questions in data from the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS: The MUSIC registry was queried for patients undergoing post-RP PSMA-PET. PSMA-PET reports were prospectively abstracted starting in July 2023, with older scans backfilled opportunistically as patients were updated in the registry. Rates and location of most distant disease (in order from most to least distant: visceral/other mets, extra-pelvic nodes/bone, pelvic nodes, prostate bed, or negative) were tabulated and compared by PSA at time of scan (< =0.5 ng/dL vs.>0.5 ng/dL). RESULTS: 397 scans were included; 58% were performed at a PSA of < =0.5. 60% of scans were positive, with the most distant disease in the prostate bed in 7%, pelvic lymph nodes in 23%, and extra-pelvic nodes or bone in 26%. The Figure 1 shows imaging results stratified by PSA. Though 46% of scans at PSA < =0.5 were negative, 17% revealed distant metastasis. CONCLUSIONS: Real-world post-RP PSMA-PET findings accord with results from specialized academic medical centers. A significant amount of extra-pelvic disease detected at a PSA range commensurate with salvage RT suggests that PSMA-PET may dramatically change planned treatment. Nonetheless, a high rate of negative scans at low PSA leaves a significant proportion of patients with a management dilemma and suggests that a negative PSMAPET alone should not preclude salvage RT.

Volume

213

Issue

5S

First Page

e1174

Last Page

e1174

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001110136.41716.b7.17

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