Guideline of guidelines: PSMA PET in staging newly diagnosed intermediate-risk prostate cancer

Abstract

Objective: To provide a comprehensive review and analysis of guidelines from various professional and medical organisations regarding the use of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) as a staging scan for men with newly diagnosed intermediate-risk prostate cancer (PCa).

Materials and methods: English-language guidelines and recommendations from the following associations and societies were reviewed and critically analysed: European Association of Urology (EAU), American Urological Association (AUA), National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE), Canadian Urological Association (CUA), American Society for Clinical Oncology (ASCO), Society for Nuclear Medicine and Medical Imaging (SNMMI).

Results: There is significant disagreement among guidelines regarding whether PSMA PET is a useful staging tool for men with a new diagnosis of intermediate-risk PCa. There is a stronger consensus that PSMA PET is useful in staging high-risk PCa.

Conclusion: Whilst there is a growing body of evidence that supports the use of PSMA PET in newly diagnosed PCa, there is significant disagreement regarding its use for men with intermediate-risk disease. Recommendations are generally weak and based on expert opinions. This is an area of considerable ongoing research, and guidelines are likely to change as new evidence emerges.

Keywords: Guidelines; Intermediate‐Risk; PSMA PET; Prostate Cancer; Staging.