Accurate primary staging of renal cancer with conventional imaging is challenging. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) may serve to improve the accuracy of renal cancer staging.
To determine clinicopathological and management differences for primary renal cancer staged with PSMA PET/CT in comparison to conventional imaging.
We conducted a retrospective cohort study of PSMA PET/CT scans performed for primary staging of renal cancer and incidental renal lesions at three sites in Brisbane, Australia between June 2015 and June 2020. Clinical characteristics, imaging, and histopathology were reviewed.
Clinicopathological and management differences according to staging modality (PSMA PET/CT, conventional imaging) were assessed. Descriptive statistics were used to report demographics and clinical parameters. Nonparametric methods were used for statistical analysis. Fisher's exact test was used for comparison of small-cell size categorical variables.
From a total of 120 PSMA PET/CT scans, 61 were included (52 staging, 9 incidental) for predominantly males (74%) with a mean age of 65.1 yr (standard deviation 12.0). Most primary lesions (40/51) were clear-cell renal cell carcinoma (ccRCC; 98% PSMA-avid), eight were non-ccRCC (75% PSMA-avid), and three were non-RCC (oncocytoma; 67% PSMA-avid). PSMA PET identified a greater number of presumed metastatic lesions than conventional imaging (195 vs 160). A management change was observed for 32% of patients (20% major, 12% minor). Limitations include the retrospective design and selection bias, lack of blinding to PSMA reporting, and the use of different PSMA radiotracers.
PSMA PET/CT detected more metastases than conventional imaging and most renal cancers were PSMA-avid, resulting in a management change for one-third of the patients.
We looked at a newer type of scan called PSMA PET/CT for first staging of kidney cancer. We found that this detects more metastasis and helps in decisions on changes in treatment for some patients. This type of imaging is a useful addition to conventional scans in tricky cases and may help in better selection of suitable treatments, but more studies are required.
European urology focus. 2024 Jan 08 [Epub ahead of print]
Arsalan Tariq, Adam Pearce, Handoo Rhee, Samuel Kyle, Sheliyan Raveenthiran, Anita Pelecanos, Chun Loo Gan, Jeffrey C Goh, David Wong, Rhiannon McBean, Phillip Marsh, Steven Goodman, Nigel Dunglison, Rachel Esler, Anojan Navaratnam, John W Yaxley, Paul Thomas, David A Pattison, Matthew J Roberts
Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia., Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Wesley Urology Clinic, The Wesley Hospital, Brisbane, Australia., Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Urology, Princess Alexandra Hospital, Brisbane, Australia., Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia., Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Urology, Redcliffe Hospital, Redcliffe, Australia., QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia., Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia., Department of Radiology & Nuclear Medicine, The Wesley Hospital, Brisbane, Australia., Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia., Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia., Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Wesley Urology Clinic, The Wesley Hospital, Brisbane, Australia., Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia., Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Urology, Redcliffe Hospital, Redcliffe, Australia; UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia. Electronic address: .