Jason Efstathiou, MD, PhD

Panelists discuss how high-quality imaging is crucial for accurately staging prostate cancer, guiding treatment decisions, and optimizing patient outcomes. Superior resolution and sensitivity of PSMA PET tracers enhance lesion detection, influencing surgical, radiation, and systemic therapy choices. Differences in tracer properties impact specificity, affecting treatment planning. Advanced imaging reduces uncertainty, improving risk stratification and therapeutic precision.

Panelists discuss how medical professionals select PSMA PET tracers based on factors such as diagnostic accuracy, tracer availability, patient-specific considerations, and logistical aspects such as half-life and production facilities. Fluorine-18 (^18F)–labeled tracers, such as ^18F-PSMA-1007, offer logistical advantages due to their longer half-life and higher image resolution, facilitating broader clinical application.

Panelists discuss how PSMA PET imaging utilizes various tracers, each with distinct properties influencing image quality and diagnostic accuracy. Fluciclovine F18 (Axumin) is primarily used for detecting recurrent prostate cancer, offering moderate sensitivity but lower specificity compared with PSMA-targeted agents. Gallium Ga-68 gozetotide (Illuccix) provides high sensitivity and specificity for prostate cancer lesions; however, its shorter half-life and limited availability may restrict widespread use. Piflufolastat F18 (Pylarify) combines the benefits of F18’s longer half-life with high image resolution, enhancing detection accuracy. Similarly, flotufolastat F18 (Posluma) leverages F18’s favorable imaging characteristics, offering high-quality images and reliable lesion detection.

Panelists discuss how prospective randomized data, notably from Hofman et al (Lancet, 2020), demonstrate that PSMA PET-CT exhibits superior diagnostic accuracy compared with conventional imaging in detecting pelvic nodal and distant metastases in patients with high-risk prostate cancer. Conventional imaging techniques, such as CT and bone scans, often have lower sensitivity and specificity, potentially missing smaller or early metastatic lesions. In contrast, PSMA PET-CT offers enhanced sensitivity and specificity, leading to more precise staging and management decisions.