The adoption of PSMA PET imaging for prostate cancer care varies significantly across different practice settings, as discussed by a panel of experts. Despite its clinical advantages, PSMA PET remains underutilized in certain areas. Dr. Ghesani questioned if the adoption rates differ notably between academic and private practices, as well as between urban and community settings. Dr. Yonover observed an estimated 80-20 split in clinician acceptance, where most are quick to adopt molecular imaging, while a smaller group continues to rely on conventional imaging methods.

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Dr. Yonover attributed some ongoing resistance to the fact that foundational studies on metastatic disease were published before the introduction of PSMA PET, resulting in definitions that do not align with molecular imaging findings. Dr. Mendel shared a similar experience within his referral network, noting he still encounters patients labeled as non-metastatic based solely on bone scans and CT scans. He highlighted the challenge of persuading these patients—who have been informed they are treatable—that an additional PSMA PET scan is necessary, especially when cost concerns are involved.

Dr. Yonover emphasized the effectiveness of PET imaging in patient discussions, explaining that patients who typically track their PSA levels as numerical values respond differently when they can visually see their disease status or treatment results through scans. Dr. Ghesani pointed out that his network conducts several clinical trials for prostate cancer that still require conventional bone scans and CT in addition to PSMA-guided imaging, allowing for direct comparisons.

He noted that conventional bone scans often fail to detect marrow-based lesions that haven’t caused cortical disruption, as these lesions do not provoke an osteoblastic response, making them undetectable by traditional methods despite being easily identifiable on PSMA scans. This reinforces the panel's view that molecular imaging offers significantly higher sensitivity than conventional staging techniques, particularly in the early phases of the disease.

The next episode in this discussion series will focus on a case involving a patient with biochemical recurrence and an indeterminate rib lesion.