Does PSMA-PET/CT make an additional contribution to the identification of active surveillance patients?

Prostate cancer is the second most common type of cancer in men, after lung cancer. In 2020, there are approximately 1.4 million newly diagnosed prostate cancer patients in the world. Even with today's technology, it continues to exist as the 3rd most common cancer causing mortality among men. Active surveillance is the regular follow-up of patients with prostate cancer, who are in the low-risk group, without giving any curative treatment. The increasing importance of AS treatment increases the importance of inclusion criteria in this treatment. But there are some disadvantages of this treatment. These are situations such as the inability to clearly determine the criteria for inclusion in AS, and the inability to predict the risk of progression of the disease. Our aim is to find possible new indications by using PSMA-PET/CT in patient selection for AS, and to investigate the contribution of PSMA-PET/CT in the selection of patients to be included in AS. A total of 44 patients who met our criteria, who had undergone radical prostatectomy between 2017 and 2022, were included in the study. These 44 patients with GS (3+3) in biopsy pathologies were divided into 2 groups according to their post-surgical pathologies as those who remained as GS (3+3) and those who changed as GS>(3+3). The clinico-demographic data and the parameters obtained from PSMA-PET/CT images taken between these two groups were compared. These parameters were determined as mean tumor volume (MTV), mean tumor volume/prostate volume, housefield unit of prostate, seminal vesicle and lymph node involvement, SUVmax value of prostate, SUVmax values of spleen and liver, ratio of prostate SUVmax values to spleen and liver, and tumor localizations. No statistically significant difference was observed between these 2 groups in terms of the mentioned parameters. We think that we could not provide a sufficient number of patient population, therefore we could not reach statistically significant data. It seems that larger population and comprehensive studies will reach meaningful results in this regard, PSMA-PET/CT will contribute to the selection of patients for AS and inclusion criteria will be expanded.