Abstract
Low detection rate of conventional imaging and unspecific fluctuations of PSA can hamper early diagnosis of castration-resistant prostate cancer (CRPC). We thus assessed the value of PSMA-PET/CT in the detection of early CRPC (PSA ≤3 ng/mL). Methods: We identified 55 patients with early CRPC (PSA≤3 ng/mL) from our institutional database. PSMA-PET/CT and its CT component were interpreted independently by three blinded readers. Primary endpoint was the per-patient detection rate, secondary endpoints were interobserver agreement, and predictors of PET-positivity. Results: PSMA-PET/CT was positive in 41/55 (75%) patients. 16/55 (29%) patients had local disease only, 25/55 (45%) had M1-disease. Overall PSMA-PET/CT interobserver agreement was substantial by Landis and Koch criteria (Fleiss’ kappa 0.77). Conclusion: PSMA-PET/CT localized prostate cancer in 75% of patients. Detection of early CRPC facilitates disease-delaying therapies for local/oligometastatic disease. PSMA-PET/CT is of value in early CRPC and should be included in EAU/PCWG3 CRPC entry criteria.
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