Understanding of metastatic prostate cancer is mainly defined by macroscopic findings, but prostate-specific membrane antigen (PSMA) PET has increased sensitivity. PSMA+ serosal-based findings on the surface of the liver and other organs might not have the same implications when seen on PSMA PET versus conventional imaging. Awareness of this phenomenon is important in assessing whether treatment escalation is truly required.
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References
Madan, R. A., Mena, E., Lindenberg, L. & Choyke, P. L. With new technology comes great responsibility: prostate-specific membrane antigen imaging in recurrent prostate cancer. J. Clin. Oncol. 40, 3015–3019 (2022).
Issa, W. et al. Treatment outcomes for patients with Ga68-PSMA-PET prostate cancer (PC) with or without conventional imaging correlates. J. Clin. Oncol. 42 (Suppl. 16), 5078 (2024).
Einstein, D. J., Aragon-Ching, J. B., Karzai, F. & Madan, R. A. Biochemically recurrent prostate cancer in the era of EMBARK and PSMA PET imaging: everything has changed, except the patients. Curr. Opin. Oncol. 36, 164–168 (2024).
Deek, M. P. et al. Long-term outcomes and genetic predictors of response to metastasis-directed therapy versus observation in oligometastatic prostate cancer: analysis of STOMP and ORIOLE trials. J. Clin. Oncol. 40, 3377–3382 (2022).
Halabi, S. et al. Meta-analysis evaluating the impact of site of metastasis on overall survival in men with castration-resistant prostate cancer. J. Clin. Oncol. 34, 1652–1659 (2016).
Madan, R. A. et al. Prospective monitoring of prostate specific membrane antigen–positive biochemically recurrent prostate cancer (PSMA+ BCR): preliminary data from 6-month PSMA follow-up. J. Clin. Oncol. 43 (Suppl. 16), 5098 (2025).
Bubendorf, L. et al. Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum. Pathol. 31, 578–583 (2000).
US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/study/NCT05588128 (2025).
Sutera, P. et al. Clinical and genomic differences between advanced molecular imaging-detected and conventional imaging-detected metachronous oligometastatic castration-sensitive prostate cancer. Eur. Urol. 84, 531–535 (2023).
Delchambre, E., Rysselinck, S., Pairet, G., Confente, C. & Seront, E. Isolated peritoneal carcinomatosis in prostate cancer: from a successful hormonal management to a review of the literature. Future Sci. OA 7, FSO707 (2021).
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The contributions of the NIH author(s) were made as part of their official duties as NIH federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the author(s) and do not necessarily reflect the views of the NIH or the US Department of Health and Human Services.
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Abel, M.L., Mena, E., Lindenberg, L. et al. Ominous-appearing serosal findings on PSMA imaging might belie indolent clinical course. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01083-x
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DOI: https://doi.org/10.1038/s41585-025-01083-x