Clinical impact of PSMA PET/CT on the management of biochemical recurrence in prostate cancer

Ga-68 prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) improves lesion detection in patients with biochemical recurrence (BCR) of prostate cancer. However, real-world evidence linking imaging-driven management changes to early biochemical outcomes remains limited, particularly in Korean populations. This study aimed to evaluate the impact of Ga-68 PSMA PET/CT on clinical management and its association with early biochemical response. This study included retrospectively registered 75 patients who underwent Ga-68 PSMA PET/CT for suspected BCR after radical prostatectomy between September 2022 and February 2024. Intended management at referral and final management after PET were compared. Biochemical outcomes were assessed based on follow-up prostate-specific antigen (PSA) levels. Seventy-five patients were analyzed (median age, 71 years; median PSA level, 0.30 ng/mL). PSMA PET/CT demonstrated positive findings in 28 patients (37.3%), including equivocal finding. Overall, intended management was changed in 19 patients (25.3%) following PET/CT. At after 2 years of follow-up, 49 patients achieved PSA ≤ 0.20 ng/mL, and 36 achieved PSA ≤ 0.03 ng/mL. In prostate cancer patients with suspected BCR, Ga-68 PSMA PET/CT led to clinically meaningful changes in management and influenced treatment selection in a Korean cohort. Larger prospective studies are warranted to further define its incremental clinical value.