Phase 2 trial of fluorine-18 PSMA-1007 PET/CT versus multiparametric MRI for locoregional staging of prostate cancer

The phase 2 Next Generation Trial at two centers in Alberta (Canada) investigated the accuracy of ¹⁸F-PSMA-1007 PET/CT compared with multiparametric MRI in the primary locoregional staging of intermediate-risk and high-risk prostate cancer. In this paired cohort study of 134 men undergoing radical prostatectomy, pretreatment ¹⁸F-PSMA-1007 PET/CT correctly identified the final pathological tumor stage in 61 men (45%) compared to 38 men (28%) with multiparametric MRI, a statistically significant difference (p=0.003). PSMA PET was also superior to MRI for correct identification of the dominant nodule (94% versus 83%; p=0.01), laterality (64% versus 44%; p=0.001), and extracapsular extension (75% versus 63%; p=0.01), but not seminal vesicle invasion (91% versus 85%; p=0.07). The authors conclude that these findings support the use of ¹⁸F-PSMA-1007 PET/CT in the pretreatment staging of intermediate-risk and high-risk prostate tumors.