A recent study by the UCLA Health Jonsson Comprehensive Cancer Center unveils a surprising truth about high-risk, nonmetastatic hormone-sensitive prostate cancer.
Findings published in JAMA Network Open reveal that nearly half of patients diagnosed with high-risk prostate cancer, who appeared nonmetastatic based on standard imaging techniques, actually show signs of metastatic disease when assessed using advanced prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging.
This research indicates that traditional imaging methods may fail to capture the full extent of cancer’s reach in many cases.
Transformative Potential of PSMA-PET
Dr. Jeremie Calais, a lead researcher and director of the clinical research program at the Ahmanson Translational Theranostics Division, stressed the transformative potential of PSMA-PET in accurately staging prostate cancer.
The implications of obtaining accurate staging data are vast, as they can significantly impact treatment strategies and patient outcomes.
Unlike ordinary imaging, which primarily focuses on the cancer’s physical structure, PSMA-PET utilizes tiny amounts of radioactive substances called radiotracers to highlight prostate cancer cells, offering a deeper understanding of the cancer’s biological behavior.
Need for Reevaluation of Clinical Trials
While the introduction of PSMA-PET has changed the way prostate cancer is imaged, many clinical treatment strategies still rely on clinical trials that did not incorporate this advanced imaging technology in patient eligibility criteria.
To explore the advantages of PSMA-PET over traditional methods, researchers conducted a retrospective cross-sectional analysis of 182 patients diagnosed with high-risk recurrent prostate cancer.
Initially believed to have localized disease, these individuals had qualified for the EMBARK trial, which had earlier established that the combination of enzalutamide, a hormonal therapy, with androgen deprivation therapy noticeably enhances metastasis-free survival.
However, this trial based its patient classification on conventional imaging, potentially underestimating the extent of the disease.
Further Research and Future Directions
Remarkably, the analysis showed that PSMA-PET imaging detected cancer metastases in 46% of patients who conventional imaging had cleared of any spread.
Additionally, 24% of these patients presented with five or more lesions that standard techniques had overlooked.
Researchers expressed that their hypothesis—that PSMA-PET would reveal more concerning findings than standard imaging—was confirmed.
However, they were taken aback by the level of metastatic disease found in a clearly defined group of patients resembling those in the EMBARK trial.
These insights necessitate a reassessment of earlier studies, including the EMBARK trial, and underscore the importance of integrating PSMA-PET into the design of future clinical trials and patient selection for prostate cancer treatments.
This crucial discovery encourages a reevaluation of treatment options and opens the door for curative possibilities, such as targeted radiotherapy.
It also raises important conversations about the role of advanced imaging in standard clinical practice.
Although this study highlights the promising benefits of PSMA-PET, further research is needed to broaden our understanding of its applicability and assess its long-term impact on patient outcomes.
Ongoing investigations at UCLA focus on analyzing follow-up data from four clinical trials to understand how PSMA-PET findings influence treatment decisions and patient results.
Furthermore, the team is part of an international consortium that is examining prognostic data from over 6,000 patients to delve deeper into the significance of PSMA-PET imaging, which is an essential part of this ongoing exploration.
Source: ScienceDaily