PSMA PET Improves Characterization of Dural-Based Intracranial Lesions in Patients with Metastatic Prostate Cancer - Beyond the Abstract

PSMA PET has been increasingly used in high-risk primary, recurrent, and metastatic prostate cancer patients. With its increasing use, we encounter several dural-based intracranial lesions such as metastases, meningiomas, pituitary adenoma, gliomas, other infections, and inflammation, with variable PSMA avidity. This study addresses a challenging issue in the management of metastatic prostate cancer: the differentiation between dural metastases and meningiomas.

As both lesions can show a similar appearance on imaging sometimes, the ability to accurately distinguish between them is crucial for guiding treatment strategies and improving patient outcomes. The authors rightly highlight the utility of PSMA PET/CT in dural metastases in prostate cancer patients and the potential for misdiagnosis due to the overlapping PSMA expression with meningiomas. This overlap can lead to delayed or inappropriate treatments, making the study’s focus on improving diagnostic accuracy particularly relevant in a clinical setting where precise characterizations are essential.

The standardized uptake values (SUV) from PSMA PET were measured for quantitative evaluation, which was significantly higher in dural metastases than meningiomas (SUVmax: 2.7 vs 11.5, p=0.001, and SUV ratio 0.26 vs 1.05, p-values <0.001). The results are compelling, demonstrating a statistically significant difference in SUVmax and SUV ratio to parotid between meningiomas and dural metastases. However, this retrospective study was not targeted to look at changes in clinical outcomes and management, PSMA PET has the potential to guide further management.

In summary, PSMA PET can become a reliable tool in conjunction with conventional imaging for distinguishing dural lesions in metastatic prostate cancer patients. Overall, this study contributes valuable insights into the diagnostic capabilities of PSMA PET imaging for characterizing intracranial lesions in metastatic prostate cancer. Distinguishing dural metastases from meningiomas effectively, it paves the way for improved clinical management and better outcomes for patients facing this challenging aspect of their disease.

Written by: Divya Yadav, MD, Joseph Osborne, MD, PhD, and Jana Ivanidze, MD, PhD

Department of Radiology, Weill Cornell Medicine, NY, United States

Reference:

  1. Yadav D, Dutruel SP, O'Dwyer E, Ricaurte-Fajardo A, Upadhyay R, Palmer JD, Pannullo SC, Tagawa ST, Knisely JPS, Brandmaier A, Osborne JR, Ivanidze J. PSMA PET improves characterization of dural-based intracranial lesions in patients with metastatic prostate cancer. Eur J Radiol. 2024 Nov;180:111711. doi: 10.1016/j.ejrad.2024.111711. Epub 2024 Aug 30. PMID: 39226675.
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