ArticleEJNMMI research2026
The impact of PSMA-PET/CT on clinical decision-making in primary staging of prostate cancer.
Article in EJNMMI research, 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
backgroundAccurate staging is essential for optimal management of prostate cancer. Conventional imaging with computed tomography and bone scintigraphy has limited sensitivity and specificity, particularly for small-volume disease. Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) has emerged as a more sensitive modality, but its impact on clinical decision-making in primary staging remains to be fully defined. In this retrospective single-center study, we evaluated the impact of PSMA-PET/CT on treatment strategies compared with conventional imaging in patients with intermediate- and high-risk prostate cancer at Skåne University Hospital, Sweden, between October 2020 and December 2022. All patients underwent [
resultsA total of 287 consecutive patients were included, of whom 59 (21%) had intermediate-risk and 228 (79%) high-risk disease. Overall, 187 patients (65%) had negative findings on all imaging modalities, while 100 (35%) had positive findings. PSMA-PET/CT identified lesions in 94 patients, whereas only 6 patients had positive findings exclusively on conventional imaging. PSMA-PET/CT led to a change in clinical management in 65 patients (22.6%), including major changes in 31 (10.8%), medium changes in 28 (9.9%), and minor changes in 6 (2.1%). Among patients with positive PSMA-PET/CT findings (n = 94), 32.0% experienced major, 29.8% medium and 5.2% minor treatment modifications. Management changes were more frequent in high-risk patients (24.6%) compared to intermediate-risk patients (15.3%).
conclusionPSMA-PET/CT provides actionable information that leads to changes in clinical management in approximately one in four patients undergoing primary staging of prostate cancer, with the greatest impact observed in high-risk disease. These findings support the integration of PSMA-PET/CT into routine staging to enable more precise and individualized treatment planning.
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