Combining MRI and PSMA PET scans for prostate cancer patients?

Since the publication of the pro PSMA trial during COVID, by my friend Declan Murphy and his team from Australia, we have changed practice and use a PSMA PET scan to make sure there is no cancer outside the prostate before robotic assisted radical prostatectomy in patients with a Gleason score of 4+3 and above. This is what we call a “staging scan” and is far more accurate than the traditional bone scan which was standard of care for many years.

The question now is whether a PSMA PET scan can improve diagnosis of prostate cancer when combined with a MRI scan of the prostate? The growing evidence is that it can.

This is presented as a podcast and video in the British Journal of Urology International (BJUI), a journal that I was proud to edit for nearly a decade as its 10th Editor in Chief.

Congratulations go to the authors of the PRIMARY trial which shows that combining MRI and PSMA PET can increase the sensitivity from 83% to 97%. In case you are wondering, nothing in life is 100% but this is a significant improvement from MRI alone! This could become a game changer in patients where the prostate cancer is not well visible on MRI despite clinical suspicion such as a rising PSA test. We know that MRI scans are not 100% accurate in excluding prostate cancer and a combination with PSMA PET can improve that accuracy. It could also avoid unnecessary biopsies in some patients.

Much more controversial is whether we can avoid a biopsy altogether in some patients where the spots within the prostate suspicious of cancer on MRI scan shine up brightly on PSMA PET scan, and proceed straight to treatment such a robotic assisted radical prostatectomy without the need for a biopsy? This is not yet standard of care but please watch this space....

The other important premise is whether with these changing trends, insurers are convinced about covering the costs of a PSMA PET scan.

For further details please enjoy the excellent video on the BJUI website on the PRIMARY trial.

The images below acknowledge the PRIMARY trial. These results are clinically relevant and important for our patients and it is a pleasure to highlight them for you.

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