Title : Updates on controversies surrounding the staging and management of newly diagnosed localized prostate cancer using Prostate-Specific Membrane Antigen (PSMA) positron emission tomography
Abstract:
Prostate cancer is a very common malignancy in men, particularly in the Western world, although its incidence is lower among Asians. It can be identified using the relatively new prostate-specific membrane antigen (PSMA) positron emission tomography (PET), a highly sensitive and specific imaging modality for prostate cancer. For disease localized to the prostate, several management options are available. This talk highlights significant updates on controversial issues relevant to cancer patients, caregivers, and researchers.
One major controversy concerns the appropriate timing of PSMA PET. Conventional imaging such as computerized tomography (CT) or bone scans are not required before ordering PSMA PET; in other words, CT or bone scans are not prerequisites. PSMA PET is a modern, more effective technique that can be used as a frontline imaging tool. However, studies from different countries have reported conflicting findings regarding its cost‑effectiveness, raising questions about whether its routine use is economically justified.
Following accurate staging with PSMA PET, subsequent management will be discussed, incorporating the latest updates in a manner comprehensible to patients and researchers across disciplines.
Key Topics Include:
(1) A brief global overview addressing the sustainability and cost‑effectiveness of routine PET, as well as treatment sequencing for hormonal therapy before, during, or after radiotherapy—an area requiring further research.
(2) Various forms of hormonal therapy, collectively known as androgen deprivation therapy (ADT). Among these, gonadotropin‑releasing hormone antagonists have demonstrated better response rates, lower recurrence rates, and fewer complications compared with agonists.
(3) Management of the unfavorable intermediate‑risk group, which may include prostatectomy or radiotherapy combined with 4–6 months of ADT. Radiotherapy alone may be considered for patients with co‑morbidities, Gleason score 7 (3+4), and <50% positive biopsy cores, provided an escalated radiation dose is delivered.
(4) Results from the three Prostate Advances in Comparative Evidence (PACE) studies, which show that highly focused stereotactic radiotherapy—an approach that relies heavily on PSMA PET—is as effective as surgery or conventional radiotherapy.
(5) Clinical trial evidence indicating that pelvic nodal radiotherapy provides a survival benefit, suggesting that regional lymph nodes should be treated electively even before radiologic evidence of spread.
(6) Brachytherapy, a radiotherapy technique that delivers radiation very close to the tumor, thereby sparing adjacent normal tissues. A brachytherapy boost offers superior outcomes compared with an external beam boost, eliminating the need for ADT in intermediate‑risk cancers and reducing ADT duration to six months in high‑risk cancers. Notably, even short‑term use (4–6 months) of gonadotropin‑releasing hormone agonists can contribute to cardiac morbidity.
The keynote speech will introduce foundational concepts and modern treatment approaches in a stepwise manner, enabling the audience to understand the latest advances in prostate cancer management clearly and effectively.
