Real-world experience with PSMA-PET in primary staging and biochemical recurrence settings: data from the Michigan Urological Surgery Improvement Collaborative.

[INTRODUCTION] Prostate specific membrane antigen-positron emission tomography (PSMA-PET) is guideline recommended across multiple clinical scenarios, but the real-world adoption and performance characteristics of this novel technology remain underreported.

[METHODS] Patients undergoing PSMA-PET imaging in either primary staging or post-prostatectomy settings were reviewed within the Michigan Urological Surgery Improvement Collaborative (MUSIC) data registry. Adoption over time and rates of positive findings by location and risk group at diagnosis (staging setting) or PSA level at time of scan (post-prostatectomy setting) were tabulated. Staging PSMA-PET findings were compared to pelvic lymph node dissection yield and characteristics associated with false negative PSMA-PET were explored.

[RESULTS] The study cohort comprised 2,433 PSMA-PET scans amongst 2,342 patients. Adoption increased over the study period-up to 46% of high-risk patients underwent staging PSMA-PET by 2024. Positive and negative predictive value for pelvic lymph node pathology were 21.1% and 92.0%, respectively. Patients with positive lymph node pathology despite negative PSMA-PET had higher Gleason Grade (p=0.034) and pT stage (p<0.001) compared to patients with negative imaging and pathology. 58.1% of scans were positive in the post-prostatectomy setting, with significant rates of positive imaging findings seen at low PSA values (32% amongst patients with PSA < 0.2 ng/mL at time of imaging).

[CONCLUSIONS] PSMA-PET has seen widespread adoption; real world performance characteristics show modest divergence from those reported in clinical trials. Further work will more directly assess the impact of this novel imaging modality on patient management.