PSMA imaging has recently become a major milestone in the examination, monitoring, and treatment of prostate cancer patients, especially in cases of biochemical recurrence and prior to targeted therapy selection. Recently, there has been growing evidence supporting the use of this advanced technology in earlier stages, even before an official diagnosis, particularly for patients with a high clinical suspicion who have experienced previous negative biopsies.

In an important new article recently published in the prestigious European Journal of Nuclear Medicine and Molecular Imaging (2026), researcher Egesta Lopci and her colleagues presented the PROSPET-BX study. This is a groundbreaking prospective study comparing different imaging technologies head-to-head.

Key Findings of the PROSPET-BX Study:

  • Study Design: The prospective study compared 68GaPSMA-11 PET/CT and multiparametric MRI (mpMRI) in parallel among 130 men with a high suspicion of prostate cancer who had previously undergone at least one negative biopsy.
  • Detection Rate: Out of the 130 participants, 20 patients (15.4%) were diagnosed with clinically significant prostate cancer (csPCa), while the vast majority (73%) had negative biopsy results.
  • Improved Diagnostic Accuracy: The study found that the diagnostic accuracy for detecting clinically significant prostate cancer was significantly higher when using the PRIMARY score (for PSMA imaging), standing at 92%, compared to an accuracy of only 83% using the traditional PI-RADS score for mpMRI.
  • PSMA Superiority: The researchers concluded that 68GaPSMA-11 PET/CT demonstrates better and more efficient performance than mpMRI in patients requiring a repeat biopsy.
  • New Predictive Tool: Based on these findings, the researchers developed a nomogram called PRIMER, designed to evaluate and predict the likelihood of the presence of clinically significant prostate cancer even before performing the biopsy.

The Importance of Molecular Imaging with PSMA

The article's findings shed light on the crucial importance of molecular imaging using PSMA in improving diagnostic accuracy. The ability of this method to provide a clear molecular picture prior to the procedure, predict the likelihood of the disease, and guide the biopsy in a targeted manner towards the most suspicious areas, is a true "game-changer". It allows for a significant reduction in the need for unnecessary repeat biopsies, prevents patient suffering, and streamlines the entire diagnostic and treatment process.

 

The full study is available in the European Journal of Nuclear Medicine and Molecular Imaging: https://link.springer.com/article/10.1007/s00259-026-07829-y

 

Source:

Lopci, E., Lazzeri, M., Saita, A. et al. [68Ga]PSMA-11 PET/CT vs. mpMRI in patients with a high suspicion of prostate cancer and previous negative biopsy: head to head, parallel, prospective trial (PROSPET-BX). Eur J Nucl Med Mol Imaging (2026).