Real world report: PSMA-PET/CT-guided TNM restaging and its consequences for treatment planning in prostate cancer

Objective: This study aimed to explore the effect of prostate-specific membrane antigen (PSMA) positron emission tomography and computed tomography (PET/CT) on clinical TNM (cTNM) staging assessment and treatment decision-making in prostate cancer,providing real-world evidence for its clinical application in China. Methods: We retrospectively analyzed the clinical data of 125 prostate cancer patients who underwent PSMA PET/CT at Chongqing University Cancer Hospital from January 2019 to June 2022. The results were compared with traditional imaging methods (bone scan, CT, MRI) in the overlapping subset of patients with both examinations to assess changes in TNM staging and treatment plans. Results: After PSMA PET/CT, TNM staging changed in 48 patients (38.40%), particularly in the primary prostate cancer and pre-radical surgery groups regarding regional lymph node detection (P = 0.007, P = 0.040). CTNM staging was revised in 36 patients (28.80%), most significantly in the post-radical surgery and mCRPC groups (47.06% and 55.88%, respectively; P = 0.036, P = 0.000). Changes in treatment plans did not reach statistical significance for newly diagnosis of Prostate and pre-radical surgery group (P = 0.222,P= 0.151). Conclusion: PSMA PET/CT significantly impacts cTNM staging assessment and treatment decisions in prostate cancer, offering precise evaluation and auxiliary diagnosis.