Impact of ⁶⁸ Ga-PSMA-11 PET/CT on the management of prostate cancer patients with biochemical recurrence

In this prospective survey of referring physicians, we investigated whether and how ⁶⁸ Ga-labeled prostate-specific membrane antigen 11 ( ⁶⁸ Ga-PSMA-11) PET/CT affects the implemented management of prostate cancer patients with biochemical recurrence (BCR). Methods: We conducted a prospective survey of physicians (NCT02940262) who referred 161 patients with prostate cancer BCR (median prostatespecific antigen value, 1.7 ng/mL; range, 0.05-202 ng/mL). Referring physicians completed one questionnaire before the scan to indicate the treatment plan without ⁶⁸ Ga-PSMA-11 PET/CT information (Q1; n 5 101), one immediately after the scan to denote intended management changes (Q2; n 5 101), and one 3-6 mo later to document the final implemented management (Q3; n 5 56). The implemented management was also obtained via electronic chart review or patient contact (n 5 45). Results: A complete documented management strategy (Q1 1 Q2 1 implemented management) was available for 101 of 161 patients (63%). Seventy-six of these (75%) had a positive ⁶⁸ Ga-PSMA-11 PET/CT result. The implemented management differed from the prescan intended management (Q1) in 54 of 101 patients (53%). The postscan intended management (Q2) differed from the prescan intended management (Q1) in 62 of 101 patients (61%); however, these intended changes were not implemented in 29 of 62 patients (47%). Pelvic nodal and extrapelvic metastatic disease on ⁶⁸ Ga-PSMA-11 PET/CT (PSMA T0N1M0 and PSMA T0N1M1 patterns) was significantly associated with implemented management changes (P = 0.001 and 0.05). Conclusion: Information from ⁶⁸ Ga-PSMA-11 PET/CT brings about management changes in more than 50% of prostate cancer patients with BCR (54/101; 53%). However, intended management changes early after ⁶⁸ Ga-PSMA-11 PET/CT frequently differ from implemented management changes.