University of California, Los Angeles (UCLA) Health has announced results from a trial that utilised advanced imaging to discover hidden metastases in high-risk prostate cancer patients.
The study employed advanced prostate-specific membrane antigen–positron emission tomography (PSMA-PET) imaging technology.
The UCLA Health Jonsson Comprehensive Cancer Center study revealed that many high-risk nonmetastatic hormone-sensitive prostate cancer cases are more advanced than previously thought.
Published in JAMA Network Open, the study found that nearly half of high-risk prostate cancer patients previously classified as nonmetastatic by traditional imaging actually have metastatic disease.
PSMA-PET imaging identified these hidden metastases, suggesting that conventional methods may underestimate cancer spread in many cases.
The technology uses tiny amounts of radiotracers that bind to prostate cancer cells, making them visible on PET scans.
Unlike conventional imaging, which only shows anatomical details, PSMA-PET provides functional imaging, revealing the cancer’s biological activity.
To better understand PSMA-PET’s advantages, researchers conducted a post hoc study using data from 182 high-risk recurrent prostate cancer patients eligible for the EMBARK trial.
The trial demonstrated that adding enzalutamide to androgen deprivation therapy improves metastasis-free survival. However, it relied on conventional imaging, which may have underestimated the extent of the disease.
The study found that PSMA-PET detected metastases in 46% of patients, despite traditional imaging showing no cancer spread. Additionally, 24% of patients had five or more lesions missed by conventional imaging.
David Geffen School of Medicine visiting assistant professor and study first author Adrien Holzgreve said: “We anticipated that PSMA-PET would detect more suspicious findings compared to conventional imaging.
“However, it was informative to uncover such a high number of metastatic findings in a well-defined cohort of patients resembling the EMBARK trial population that was supposed to only include those without metastases.”
UCLA Health said these findings challenge the interpretation of past studies, such as the EMBARK trial, and advocate for incorporating PSMA-PET in patient selection for both clinical and trial interventions in prostate cancer.
The healthcare system said that ongoing research is necessary to explore PSMA-PET’s broader applications. Further studies will help in evaluating the technology’s long-term impact on patient outcomes.
Ongoing efforts at UCLA involve analysing follow-up data from four UCLA trials to determine how PSMA-PET findings influenced treatment decisions and patient outcomes.
In addition, the research team is part of an international consortium studying over 6,000 patients to explore the prognostic value of PSMA-PET.
