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TO PET OR NOT: EVALUATING THE APPROPRIATENESS OF PSMA PET SCANS IN UNFAVORABLE INTERMEDIATE RISK PROSTATE CANCER
Mahan Najhawan, MD1, Edward Hawke, DO2, Deeba Zadeh, BS3, Cole Astin, BS, MPH3, Evan Sinnathamby, MD2, Emma Hillis, MSPH2, Sean Collins, MD2, Michael Maddox, MD2, Kyle Rose, MD2, Stephen Bardot, MD2, Vani Vijayakumar, MD2, Rohith Arcot, MD2.
1UMass Chan/Ochsner Clinic Foundation, Worcester, MA, USA, 2Ochsner Clinic Foundation, New Orleans, LA, USA, 3University of Queensland - Ochsner Clinical School, New Orleans, LA, USA.
Introduction: The National Comprehensive Cancer Network (NCCN) recommends imaging prior to localized treatment for prostate cancer (PCa) in those with unfavorable-intermediate risk (UFIR), high risk (HR), and very high-risk (VHR) PCa. Since metastatic risk varies greatly between these groups, routine PSMA PET scans in UFIR patients may constitute overuse. Our study aims to evaluate the PSMA PET positivity rates in these at-risk populations and identify clinical factors associated with positive scans.
Methods: A retrospective chart review was conducted from August, 2024-June, 2025, at the Ochsner Clinic Foundation. Only patients with pretreatment scans, complete clinicodemographic data, and UFIR, HR, or VHR PCa were included. Key data extracted included age, race, family history, PSA, grade group (GG), clinical T-stage, total biopsy cores, positive cores, and PSMA positivity. Univariate and multivariate logistic regression models were fit to identify clinical variables associated with a positive scan.
Results: Our cohort included 500 men with 77 positive scans. PET positivity rates were 3.1% (7/223), 10.5% (20/191), and 58.1% (50/86) for UFIR, HR, and VHR men, respectively. On univariate analysis, HR and VRH men had an OR 3.38 (CI 1.39-8.22, p=0.0074) and 41.46 (17.43-98.61, p <0.0001), respectively, when compared with UFIR men for a positive scan. On multivariate analysis, scan positivity was significantly associated with GG4, GG5, PSA >20 ng/mL, PSA >40 ng/mL, and clinical stage cT3-cT4, all features of HR or VHR disease.
Conclusion: We observed a PSMA PET positivity rate of only 3.1% among UFIR PCa patients, suggesting limited utility despite NCCN guideline recommendations. Further work is needed to identify which UFIR clinical factors confer the highest metastatic risk, to better select patients who may benefit from pretreatment PET imaging.
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