EAU15: Value and limitations of PET/CT in PCa

Dr. Stefano Fanti (IT) pointed out the limitations of PET/CT in the diagnosis and initial staging of prostate cancer while Dr. Alberto Briganti (IT) focused on the use of the imaging technique in disease recurrence.

“The question in the title of my presentation – Is PET/CT helpful in diagnosis and initial staging of PCa? – made me consider if I should set the record for the shortest presentation at the EAU Congress by simply saying ‘no’ and leaving it at that,” Fanti jokingly said at the start of his presentation. He went on to present evidence that demonstrates the limited use of Choline-PET in prostate cancer.

Several studies have shown that PET/CT has no use in prostate cancer diagnosis, and is actually not recommended in this setting. In staging N+ and M+ disease, Fanti showed PET/CT’s specificity is not bad but its sensitivity is below 50% which is unacceptable. Moreover, lesions that are smaller than 5 mm are invisible on the scans.

“We can’t make any predictions for the future,” Fanti concluded, “…but today PET/CT has no use in diagnosis and staging of prostate cancer.” The only setting in which the technique currently proves its value is in biochemical recurrence.

Briganti agreed and stressed the importance of PET/CT in prostate cancer recurrence. He showed that the imaging technique is particularly useful in patients with a high PSA level and a low PSA doubling time. Nonetheless, PET/CT has limitations in lesion-based analyses.

“PET/CT definitely has a place in diagnosing and monitoring prostate cancer recurrence, but we need to be smart enough to recognise the setting in which to use it. Make sure you use it in high-risk patients,” Briganti said.