PSMA PET/CT in diagnosing and staging high grade prostate cancer: accuracy and cost-effectiveness

INTRODUCTION: To evaluate accuracy and costeffectiveness of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) as single procedure in diagnosing and staging high grade prostate cancer (PCa). MATERIALS AND METHODS: From June 2022 to December 2025, 330 men (median age: 65 years) underwent transperineal prostate biopsy for the suspicion of high grade PCa (PSA >20 ng/ml and/or suspicious digital rectal examination). All the patients underwent PSMA PET/CT targeted biopsy of intraprostatic lesions suspicious for PCa (Standard Uptake Value >8) combined with extended prostate biopsy. RESULTS: Median PSA was 30.5 ng/ml (range: 20-785 ng/ml) and 135/330 (41%) men had positive DRE; a csPCa was found in 325/330 (98.5%) patients and 297/325 (91.4%) had a Gleason score >8/ISUP Grade Group >4. Clinical staging by PSMA PET/CT demonstrated: 130 (40%) cT2PCa vs 195 (60%) cT3PCa cases; in detail, 95/325 (29.2%) had positive nodes, 60 (18.5%) bone metastases and 40 (12.3%) multiple metastases. The overall reimbursement for diagnosing PCa in the 330 patients submitted to prostate biopsy was 471,883,5 €.; using PSMA PET/CT without MRI the cost of this latter procedure could be spared for a total of 71,016 €. CONCLUSIONS: PSMA PET/CT as a single imaging procedure demonstrated an high accuracy in diagnosing and staging high grade PCa, moreover, improved cost-effectiveness and allowed to start quickly therapy.