The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Primary Staging of Selected Renal Tumours: Initial Experience in a Multicentre Cohort

• Published in: European urology focus 2024-09, Vol.10 (5), p.770-778
• Main Authors: Tariq, Arsalan, Pearce, Adam, Rhee, Handoo, Kyle, Samuel, Raveenthiran, Sheliyan, Pelecanos, Anita, Gan, Chun Loo, Goh, Jeffrey C., Wong, David, McBean, Rhiannon, Marsh, Phillip, Goodman, Steven, Dunglison, Nigel, Esler, Rachel, Navaratnam, Anojan, Yaxley, John W., Thomas, Paul, Pattison, David A., Roberts, Matthew J.
• Format: Article
• Language: English
• Subjects: Aged; Antigens, Surface; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - pathology; Cohort Studies; Female; Glutamate Carboxypeptidase II; Humans; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Male; Middle Aged; Neoplasm Staging - methods; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Primary staging; Prostate-specific membrane antigen; Renal cell carcinoma; Retrospective Studies; Treatment decision
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2023.12.004

Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) detects more metastases than conventional imaging and may improve staging accuracy for renal tumours in equivocal cases. PSMA PET/CT may also facilitate better selection of patients for local and systemic therapies and inform changes in treatment plans. Accurate primary staging of renal cancer with conventional imaging is challenging. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) may serve to improve the accuracy of renal cancer staging. To determine clinicopathological and management differences for primary renal cancer staged with PSMA PET/CT in comparison to conventional imaging. We conducted a retrospective cohort study of PSMA PET/CT scans performed for primary staging of renal cancer and incidental renal lesions at three sites in Brisbane, Australia between June 2015 and June 2020. Clinical characteristics, imaging, and histopathology were reviewed. Clinicopathological and management differences according to staging modality (PSMA PET/CT, conventional imaging) were assessed. Descriptive statistics were used to report demographics and clinical parameters. Nonparametric methods were used for statistical analysis. Fisher’s exact test was used for comparison of small-cell size categorical variables. From a total of 120 PSMA PET/CT scans, 61 were included (52 staging, 9 incidental) for predominantly males (74%) with a mean age of 65.1 yr (standard deviation 12.0). Most primary lesions (40/51) were clear-cell renal cell carcinoma (ccRCC; 98% PSMA-avid), eight were non-ccRCC (75% PSMA-avid), and three were non-RCC (oncocytoma; 67% PSMA-avid). PSMA PET identified a greater number of presumed metastatic lesions than conventional imaging (195 vs 160). A management change was observed for 32% of patients (20% major, 12% minor). Limitations include the retrospective design and selection bias, lack of blinding to PSMA reporting, and the use of different PSMA radiotracers. PSMA PET/CT detected more metastases than conventional imaging and most renal cancers were PSMA-avid, resulting in a management change for one-third of the patients. We looked at a newer type of scan called PSMA PET/CT for first staging of kidney cancer. We found that this detects more metastasis and helps in decisions on changes in treatment for some patients. This type of imaging is a useful addition to conventional scans in tricky cases and