Elderly patients suspected of having prostate cancer may now be able to avoid a biopsy due to a new imaging technique. According to a study published in The Journal of Nuclear Medicine, PSMA PET/CT can accurately diagnose advanced prostate cancer and aid in selecting appropriate treatment options, eliminating the need for invasive biopsies in elderly patients.
The imaging modality 68Ga-PSMA PET/CT has been widely accepted for evaluating the extent of disease in prostate cancer patients. Typically, it is used when intermediate or high-risk cancer has been identified through biopsy. However, for elderly patients, undergoing a biopsy can be associated with longer hospital stays and complications such as infection, bleeding, or urinary retention.
Because of these risks, some elderly patients are referred for PSMA PET/CT without a pre-imaging biopsy. A recent study aimed to assess the rate, clinical characteristics, and PET-based stage of elderly patients referred for PSMA PET/CT without biopsy and determine if their biopsy status affected the therapeutic approach.
The study included 100 consecutive patients aged 80 years or older who underwent staging with 68Ga-PSMA-11 PET/CT. Researchers recorded whether a pre-imaging biopsy was performed, the patients’ clinical characteristics, the PET-based staging parameters, and the primary therapy they received.
Results showed that 34 percent of patients in the study did not have a pre-imaging biopsy. These patients were generally older with worse clinical status and higher levels of prostate-specific antigen (PSA). On the 68Ga-PSMA-11 PET/CT scans, all patients without a pre-imaging biopsy were found to have avid disease, indicating higher rates of bone metastases and overall advanced disease.
Surprisingly, similar proportions of patients with and without a pre-imaging biopsy were referred for hormonal therapy. However, a stark contrast was observed in the referral rates for radiotherapy: 63 percent of patients with biopsy were referred for radiotherapy after imaging, while only 8.8 percent of patients without a pre-imaging biopsy were referred for radiotherapy.
According to Dr. Einat Even-Sapir, the head of the Department of Nuclear Medicine at Tel Aviv Sourasky Medical Center and professor of imaging at Tel Aviv University, the results of the study indicate that elderly patients referred for PSMA PET/CT based on clinical suspicion alone had 100 percent avid disease. Given that positive PSMA PET/CT results usually indicate clinically significant prostate cancer, the value of pre-imaging biopsies for patients with a high clinical suspicion seems to be questionable.
This study suggests that by using PSMA PET/CT in elderly patients who are clinically suspected of having prostate cancer, the need for a pre-imaging biopsy can be waived. Not only does this approach eliminate the risks associated with biopsies, but it also provides accurate staging information. Moreover, the low negative effect of radiation exposure in elderly patients makes this approach cost-effective and efficient.
The research findings could potentially revolutionize the diagnosis and treatment selection process for elderly patients with suspected prostate cancer. By utilizing PSMA PET/CT as a non-invasive alternative to biopsies, healthcare providers can reduce complications while ensuring accurate staging and appropriate treatment plans.
