The study focuses on the use of prostate-specific membrane antigen (PSMA)-directed applications in modern prostate cancer management. These applications have rapidly evolved, establishing new treatment pathways and providing insights into prostate cancer biology. However, the prognostic implications of PSMA-PET are not well-studied due to its rapid clinical adoption and lack of long-term follow-up data.
Current data suggest that high PSMA expression, measured by immunohistochemistry and PET uptake, is associated with traditional prognostic factors and survival outcomes in men with localized and biochemically recurrent prostate cancer. Treatment with curative intent often fails when PSMA-positive metastases are present, partly because PSMA-PET has poor sensitivity in detecting all metastases. Low PSMA-PET uptake in recurrent disease is a favorable prognostic factor but can indicate poor prognosis when combined with high 18F-fluorodeoxyglucose uptake in metastatic castration-resistant prostate cancer.
The study concludes that clinical trials embedding PSMA-PET for guiding management and providing reliable oncological outcomes are needed to support its ongoing clinical use.
