Current Use of PSMA-PET Scans for Prostate Cancer

Umesh Oza, MD: Do you think that PSMA-PET is already or eventually will be the standard of care for patients with prostate cancer? And if not, are we just on the horizon of it? What do you think, Dr. Sohi?

Jaideep S. Sohi, MD: That’s a good question. In the past year, I have had many discussions with urologists, doctors and radiation oncologists. I’d say the consensus statement is that we’re almost there. We are almost there because I am very encouraged to see that our colleagues in urology and radiation oncology have adopted PSMA-PET imaging. We see a lot more use of this mode. We still see many sites that do CT and bone scans. It’s a habit. It is a process that has been in place for many years, and you cannot expect this practice to change as quickly as we would like.

Is there a practical matter that not every site has access to a PET-CT? So, especially in rural communities, you have a CT scanner. You may have a spec machine for bone scanning, but you may not have access to PET-CT. Maybe they get a mobile PET-CT that comes once a week, once a month, and they have so many patients that they can’t fit them all on the schedule. We have to look at those scenarios. But beyond that, when available, I think we’ll see it used with greater frequency. To answer your question, I think we are almost there. I can’t say we are there today, but I think we are very close. What have you seen in your practice, because you obviously have extensive experience with this modality? And you see these patients with more frequency.

Umesh Oza, MD: Absolutely. First of all, I 100% agree with you that there is still work to be done. But … the standard of care has been established, the companies say. Nonradiological societies say so. But in my own practice, yes, I think we don’t always have these patients in front of us or this tracer to the patients that we need.

And it is multifactorial. I can’t go into all the details. But we have to get there and we have to get there fast. You mentioned mobile PETs, and so here in Texas, you know, big states, small towns everywhere, big cities too, but our small towns shouldn’t be left out. We have a robust and mobile PET service in our practice that we have partnered with one of our oncology practices. Those mobile PETs rotate and get to cover many kilometers between days and weeks, and try to do our scanners. The key is to get the tracer, then, to that scanner as well. And are we working with ready pharmacies to ensure that it is available to our patients?

I’ll give you my thoughts on this last question, and then you can add. There is still a question [about] unmet needs and clinical challenges. We both touched a little bit on accessibility and availability and things like that. I think one … unmet need is enough processes and data to know, what does all this mean? I hate that patients are being upgraded by this great modality, this great tracker, and not being offered the same conventional treatments they were getting before. I think our urological oncologists are clearly aware of this. It won’t happen overnight, but I think with time and more use to it – we’ll all learn, right? We all use it as best as we can and offer the best information and interpretation of these scans. But I’m sure you’re the same way, I learned from my clinical colleagues when I read their clinical note, or how they use our study, and how the patient responded to certain treatments, and how our PET scan. [is used]. I think you and I are just absorbing this new data and information. But the unmet need for me is still the information that comes from this scan. How will they apply to our patient population? Clearly, we need our patients on stage initially. But once that happens and the treatment starts, and that’s where we are, because we’re starting to spread this tracer. As we move forward, what will change about it? So those are my thoughts. You have something to [say about] what you feel is perhaps an unmet need, or something to look to the future before ending here, Dr. Sohi?

Jaideep S. Sohi, MD: Yes, absolutely, Dr. Oza. Fortunately, we have a lot of data, and growing, given the fact that this modality has been used in Europe and Australia for many years. Of course, we are always looking for more data and more updated information. But the good news is that we have some perspective here, going back several years with our European colleagues.

One of the unmet needs and clinical challenges I see is the need to continually educate and collaborate with our referring physicians. Make them aware…. A urologist who was talking to me, they did not know that this modality was actually offered locally at their location. Awareness of this tracer in the local area is important. Equally important is to educate and collaborate with our colleagues, radiologists, nuclear medicine doctors who … may be in a practice where [they’re] do PET once a month, once a week…. They can read 2 or 3 scans per month. There is still a lot of work to be done to educate our peers about reading [scans] and how to clean the data from this mode. We all know about artifacts, right? That can be an update and all that stuff. It is still a work in progress. I think we are going a long way. But there is still a lot of work to be done to educate our peers so that they can, then, impact patient care in the most positive way.

Umesh Oza, MD: Absolutely, I absolutely agree with that. Well, I want to thank you very much, Dr. Sohi, for your input, your insights, discussion. I always learn something when I talk to people like you. And today I definitely learned some things. So, I want to thank you, and for our audience, we hope you found this review discussion informative.

The transcript is generated by AI and edited for clarity and readability.