Compared to traditional imaging techniques, prostate-specific membrane antigen (PSMA) PET imaging superiorly detects bone metastases in prostate cancer patients, which is an important indicator of long-term patient survival. Outcomes data revealed that patients with even a single bone metastasis had faster disease progression and worse overall survival. This research was presented at the 2026 Annual Meeting of the Society for Nuclear Medicine and Molecular Imaging.
Because prostate cancer commonly metastasizes to the bones, doctors have relied on bone scans and CT scans to detect it for decades. However, these tools have limitations and often miss small cancer deposits that are already present, altering the patient’s prognosis. The new PSMA PET scan uses a radioactive tracer that binds directly to proteins on prostate cancer cells, making it much more sensitive than traditional imaging. As a result, PSMA PET has become the gold standard for prostate cancer staging at major cancer centers.
Although we know that PSMA PET scans are effective in detecting bone metastases, there is no data to show what that means in terms of overall results. In our study, we sought to determine what happens to patients over time when only one to five bone metastases are found on PSMA PET but appear completely normal on conventional scans. ”
Surekha Yadav, MBBS, Resident, Department of Radiology and Biomedical Imaging, University of California, San Francisco
This retrospective study followed 36 patients at two academic centers who had 1 to 5 bone lesions on PSMA PET at initial presentation. We reviewed conventional image processing and determined the upstaging rate. Time to biochemical recurrence, castration-resistant prostate cancer, composite endpoint, and overall survival over a median of 25 months were calculated. Treatment patterns were also recorded.
Despite bone lesions detected on PSMA PET, more than 80 percent of patients had completely normal conventional imaging studies. Compared to 984 patients in the same cohort who did not have bone metastases on PSMA PET scans, those with one to five bone lesions had more than five times the risk of progressing to treatment-resistant cancer and almost four times the risk of death.
“Treatment decisions made at the time of diagnosis have a lasting impact. If a patient’s conventional imaging tests are negative, they may be managed with a less intensive approach as if the cancer had not spread,” Yadav said. “Our study shows that when PSMA PET finds bone metastases missed by conventional imaging, these patients are not in a gray zone. Their cancer behaves more aggressively, progresses faster, and dies sooner. Many of them are now being treated based on their bone scans saying everything is fine.”
According to Yadav, patients do not have to wait to benefit from PSMA PET. It has already been approved by the FDA and is available at major academic cancer centers such as the University of California, San Francisco and the University of California, Los Angeles. “What this study changes is not access to scans, but what we do with the results,” she said. “Until now, oncologists had limited outcome data on how aggressively to treat patients whose PSMA PET revealed bone metastases that were missed by traditional imaging. Our study provides evidence of that.”
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Society of Nuclear Medicine and Molecular Imaging
