PRISMA PET: Rethinking imaging for prostate cancer staging

Dr Buch-Olsen: Guidelines have long called for randomized trials to demonstrate patient benefit from PSMA PET CT. While its diagnostic accuracy is proven, no study has examined whether staging patients with PSMA PET CT actually improves outcomes. That patient-centered endpoint was our primary motivation. Randomizing two staging modalities is unusual. This trial is extraordinary not just for its scale but for its focus on real patient benefit, setting a potential benchmark for future prostate cancer imaging studies.

Prof Poulsen: We knew PSMA PET CT was more accurate than conventional imaging. We also know from other studies that the use of PSMA-PET changes patient management, but we wanted to examine whether this change of patient management resulted in a benefit for the patient. No one had tested this in a real-world, clinical setting until now. Our randomized, multi-hospital study aimed to fill that gap.

Dr Buch-Olsen: We plan a five-year follow-up to assess overall survival and longer-term progression-free survival. If trends continue, this trial could support widespread adoption of PSMA PET CT across Europe. Guidelines could eventually reference our study as the first randomized trial directly comparing two staging modalities with patient outcomes as the endpoint.

Prof Poulsen: There’s still work ahead – longer follow-up and quality-of-life analyses. But the data already provide compelling evidence that improved imaging can meaningfully guide patient care.