PSMA PET appears to shift prostate cancer treatment intensity

PSMA PET use in newly diagnosed advanced prostate cancer was associated with higher use of intensified systemic therapy, according to a study published May 7 in JAMA Oncology.

The study evaluated whether use of prostate-specific membrane antigen PET imaging was linked to differences in initial treatment decisions when compared with conventional bone scans. Yale School of Medicine summarized the research as an analysis of how PSMA PET may lead to earlier use of advanced therapies in prostate cancer care.

Researchers used Blue Cross Blue Shield claims data for beneficiaries ages 40 to 89 who were newly diagnosed with prostate cancer between July 2021 and December 2023. Follow-up care was tracked for 12 months after diagnosis, according to Yale’s study summary.

Among 5,893 patients, 35.4% underwent PSMA PET imaging and the rest underwent conventional bone scans. PSMA PET use increased during the study period and surpassed bone scans by 2023, according to the published abstract and institutional summary.

Patients who received PSMA PET were more likely to start androgen receptor pathway inhibitor therapy than those who received bone scans. Yale reported ARPI therapy initiation in 15.6% of PSMA PET patients, compared with 7.7% of patients who underwent bone scans.

Use of systemic therapy was also higher in the PSMA PET group. The same summary reported that patients imaged with PSMA PET were more likely to receive systemic therapies and radiotherapy to metastatic sites, while fewer underwent radical prostatectomy.

The findings suggest that more sensitive molecular imaging may be changing treatment patterns by detecting disease that was previously occult on conventional imaging. That shift could lead to earlier and more intensive therapy, but the clinical value of earlier treatment based on molecular imaging remains uncertain.

The authors noted that PSMA PET provides greater disease localization than conventional imaging, but its downstream effects on treatment cost, toxicity, and value-based care require further evaluation. Yale’s summary said the results raise questions about whether earlier treatment improves survival and quality of life enough to justify additional therapy exposure.

The study was limited by the use of claims data. Clinical details such as prostate-specific antigen levels, imaging findings, disease burden, and reasons for treatment selection were not available in the dataset.