The addition of PSMA PET in selecting candidates for prostate cancer focal therapy
In brief
PSMA PET raises specificity for prostate focal therapy selection to about 90%
In a review of 60 men undergoing prostatectomy, only one-third met true focal-therapy criteria, often because of hidden bilateral disease. Adding PSMA PET to MRI and biopsy increased specificity from 80% to 90% and boosted the positive predictive value to 46%, better flagging unsuitable candidates. Prospective studies are needed to confirm its role in routine selection.
- Journal
- BJUI compass (Q1)
- Published
- 6 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Kylie Yen-Yi Lim, Mohammad Asghari-Jafarabadi, Arveen A Kalapara, Julian Smith, Mark Frydenberg, Weranja Ranasinghe
- PMID
- 42568760
- DOI
- 10.1002/bco2.70264
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 9 August 2026).
Abstract
OBJECTIVES: This study aims to evaluate whether prostate-specific membrane antigen (PSMA) PET improves detection of index lesions and refines patient selection for focal therapy (FT) compared with standard diagnostic pathways. PATIENTS AND METHODS: We performed a retrospective review of men who underwent radical prostatectomy (RP) between 2015 and 2023. Pre-operative assessment included multiparametric MRI, PSMA PET/CT and transperineal prostate biopsy. RP whole-mount histopathology served as the reference standard. Focal therapy eligibility was assessed, and diagnostic performance compared between standard-of-care selection criteria and criteria incorporating PSMA PET. RESULTS: Sixty patients (26%) met SOC criteria for FT. On final RP histopathology, only 20/60 (33.3%) were truly eligible, with discordance most commonly due to bilateral clinically significant prostate cancer (80%). Incorporation of PSMA PET into the selection model improved specificity for appropriate FT selection from 80.3% to 89.7% and positive predictive value from 33.3% to 46.2%. For detection of outfield disease, addition of PSMA PET increased sensitivity to 75.5% and negative predictive value to 53.5%. Higher SUVmax was significantly associated with FT ineligibility (AUC 0.67), with an optimal cut-point of SUVmax > 4.78 predicting unsuitable candidates. CONCLUSION: Only a small proportion of men fulfil criteria for focal therapy, with a high risk of bilateral or contralateral disease using MRI and biopsy alone. PSMA PET improves diagnostic accuracy by identifying outfield lesions and reducing inappropriate FT selection. These findings support integration of PSMA PET to optimise patient selection, with further studies in prospective focal therapy cohorts required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.