PSMA PET-CT more accurate than standard-of-care imaging in RCC

In the largest series considering the role of prostate-specific membrane antigen (PSMA) PET-CT in renal cancer, PSMA improved diagnostic accuracy compared with standard-of-care (SOC) imaging and can lead to informed treatment modification, as was found in 39% of patients.

Accurate staging of renal tumours with imaging prior to treatment is a challenging aspect of urological practice. Given the novel implications of PSMA in non-prostatic malignancies, Dr Arsalan Tariq (Royal Brisbane and Women's Hospital, Australia) and colleagues sought to further define the role of PSMA-based imaging in renal cancer. They performed a multicentre, retrospective cohort study of all PSMA PET/CT scans for primary or recurrent staging of renal cell carcinoma (RCC) and incidental renal lesions between 2015 and 2020.

Assessed were 118 PSMA PET/CT scans of mostly men (75%) with a median age of 65 years. Histopathology was performed on 55 primary lesions, of which 50 were PSMA avid (90.9%). Clear cell RCC (ccRCC) represented 42 of these primary lesions, of which 94% were PSMA avid.

PSMA PET/CT identified a greater number of nodal or metastatic lesions than SOC imaging for 36% of patients and disproved SOC imaging findings for another 10% of patients. Additionally, in lymph node staging, PSMA had a positive predictive value of 91% compared with 53% for SOC imaging, and a negative predictive value of 76% versus 29% for SOC imaging. Overall, 39% of patients had their treatment modified as a result of PSMA PET-CT imaging.

Dr Tariq argued that these results suggest that PSMA avidity may indicate a malignant primary tumour. Most primary tumours were PSMA avid and PSMA PET-CT led to improved diagnostic accuracy compared with SOC imaging and treatment modification. Further assessment in prospective studies is warranted.

1. Tariq A. Prostate Specific Membrane Antigen (PSMA) PET/CT compared to standard of care imaging in the assessment of renal cancers: A multi-institutional series. P0624, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August, 202116 February, 2024