Detection rates and disease patterns of PSMA PET/CT in prostate cancer at a national tertiary referral center: a real-world descriptive study

Justine Grangeret^1,*, Olivier Schaeffer¹, Paul Jonard¹, Joel Aerts², Philippe P. Leveque², Philippe Barthelme², Christopher Bonnier¹, Octavian Dragusin³, Christian Picard¹, Jules Zhang-Yin¹
1 Department of Nuclear Medicine, Centre National PET, Centre Hospitalier de Luxembourg, 4 Rue Ernest Barblé, Luxembourg, Luxembourg
2 Department of Radiopharmacy, Centre Hospitalier de Luxembourg, 4 Rue Ernest Barblé, Luxembourg, Luxembourg
3 Department of Medical Physics, Centre Hospitalier de Luxembourg, 4 Rue Ernest Barblé, Luxembourg, Luxembourg
* Corresponding Author: Justine Grangeret. Email: email , email
(This article belongs to the Special Issue: Advanced Multimodal Imaging for Localized Prostate Cancer and Biochemical Recurrence of Prostate Cancer)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.080433

Received 09 February 2026; Accepted 15 June 2026; Published online 17 July 2026

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Abstract

Backgrounds: Prostate-specific membrane antigen (PSMA) Positron Emission Tomography–Computed Tomography (PET/CT) is increasingly used for initial staging and biochemical recurrence (BCR) assessment in prostate cancer. The aim of this study was to describe PSMA PET/CT detection rates and disease patterns at a national tertiary referral center across initial staging and BCR. Methods: We retrospectively reviewed consecutive Gallium-68 Prostate-Specific Membrane Antigen-11 (68Ga-PSMA-11) PET/CT examinations performed between July 2021 and July 2025. The institutional database contained 554 examinations; 246 repeated examinations were excluded, leaving 308 first clinically relevant examinations. We then excluded 120 non-eligible indications (57 therapeutic assessments and 63 other indications: 21 characterization of bone lesions, 17 pre-177Lu-PSMA, and 25 pre-Xofigo), yielding a final analytic cohort of 188 patients (82 initial staging; 106 BCR). Positivity was defined as any non-physiologic uptake compatible with prostate cancer; in initial staging, intraprostatic uptake was counted as positive. Metastatic burden was categorized as non-metastatic, oligometastatic (1–3 lesions), or polymetastatic (>3 lesions). Results: Overall positivity was 157/188 (83.5%). Positivity was 82/82 (100.0%) in initial staging and 75/106 (70.8%) in BCR (p < 0.001). In the BCR cohort, positivity increased with rising Prostate-Specific Antigen (PSA): 11/29 (37.9%) for PSA < 0.5 ng/mL, 13/20 (65.0%) for PSA 0.5 to <1.0 ng/mL, 7/11 (63.6%) for PSA 1.0 to <2.0 ng/mL, 22/24 (91.7%) for PSA 2.0 to <5.0 ng/mL, and 22/22 (100%) for PSA ≥ 5.0 ng/mL. Positivity was higher after radiotherapy than after prostatectomy (42/44 vs. 33/62, p < 0.001). Among post-prostatectomy patients, 37/62 (59.7%) had vesico-urethral anastomotic recurrence. Metastatic disease was observed in 31/82 (37.8%) of initial-staging patients and 45/106 (42.5%) of BCR patients. Among 60 nodal-positive patients, 51 had pelvic and 9 extrapelvic nodal involvement. Oligometastatic disease was more prevalent in BCR (29.2%) than in initial staging (8.5%), while polymetastatic disease was more common in initial staging (29.3% vs. 13.2%). Nodal and osseous involvement predominated. Conclusions: In this real-world tertiary-center cohort, 68Ga-PSMA-11 PET/CT showed an important detection rate in initial staging and BCR, and substantial PSA-dependent detection in BCR. Post-radiotherapy recurrence was imaged at higher PSA values and showed higher detection and metastatic burden than post-prostatectomy recurrence, which enriched for oligometastatic patterns that may be actionable for metastasis-directed strategies.