Incorporating the [68Ga]Ga-PSMA PET/CT PRIMARY score into the selection criteria for prostate cancer patients eligible for active surveillance

Excerpt

Active surveillance (AS) has become a preferred strategy to minimize overtreatment in patients with low-risk prostate cancer (PCa) who do not present with severe lower urinary tract symptoms. Identifying candidates for AS and monitoring them effectively is crucial to mitigate the risk of undertreating localized disease. Currently, the selection of patients for AS is based on a combination of digital rectal examination (DRE) results, prostate-specific antigen (PSA) levels, Gleason score from prostate biopsies, and the rate of tumor-positive biopsy cores. Some protocols also incorporate PSA density, the rate of cancer in biopsy cores, and multiparametric prostate magnetic resonance imaging (mpMRI) to enhance predictive accuracy. Despite these measures, the absence of universally accepted selection standards leads to inconsistencies in identifying appropriate AS candidates. These inconsistencies may result in unnecessary curative treatments, such as radical prostatectomy or radiotherapy for patients suitable for AS, or conversely, a missed opportunity for timely intervention in high-risk patients. …