ArticleEuropean journal of nuclear medicine and molecular imaging2026
Shining the PSMA spotlight on peritoneal metastases in prostate cancer.
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to retrospectively characterize patients with biochemical failure and peritoneal metastases detected by PSMA PET/CT, describe the detectability of 18F-FDG PET/CT and conventional imaging; and assess patient outcome.
methodsWe searched an institutional database for patients who underwent 68Ga-PSMA-11 or 18 F-DCFPyL PET/CT between 5/2016 and 9/2024 and measured the SUVmax of the most avid peritoneal lesion. We assessed correlative CT, MRI, or FDG PET/CT performed within 90 days and validated peritoneal metastases via composite reference. Survival was estimated with Kaplan-Meier analysis. Seven patients subsequently treated with 177Lu-PSMA-617 were analyzed.
resultsOf 9,877 screened patients, peritoneal metastases were confirmed in 57. Most had Gleason ≥ 4 + 3 (81%) and median PSA was 10.0 ng/ml (range 0.34–1,304); 54% were castration-sensitive. Isolated peritoneal disease occurred in 19 (33%). The median SUVmax was 8.2. Among 29 patients with correlative CT/MRI, 41% were negative. Of 14 patients with correlative FDG PET/CT; 43% demonstrated FDG-avid peritoneal disease. On follow-up (n = 42), peritoneal disease improved in 38%. Of those with isolated peritoneal metastases and follow-up data (n = 12), 58% improved. Median overall survival from detection was 53 months (95% CI: 29–not reached), and associated with lower PSA, fewer peritoneal lesions, and non-castration resistance. All seven patients treated with 177Lu-PSMA-617 progressed.
conclusionPeritoneal metastases from prostate cancer are rare. Nevertheless, PSMA-avid peritoneal lesions may represent metastatic spread from prostate cancer, even in the absence of systemic disease. FDG PET/CT and CT/MRI often miss peritoneal metastases. Peritoneal disease does not necessarily indicate poor prognosis, particularly when isolated.
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