Evaluating 68Ga-PSMA PET/CT for Detecting Prostate Cancer Recurrence Post-High-Intensity Focused Ultrasound and Brachytherapy: A Single-Center Retrospective Study

How to cite: Di Giorgio A. Evaluating 68Ga-PSMA PET/CT for Detecting Prostate Cancer Recurrence Post-High-Intensity Focused Ultrasound and Brachytherapy: A Single-Center Retrospective Study. Grand Rounds in Urology. September 15, 2025. Accessed Mar 2026. https://grandroundsinurology.com/evaluating-68ga-psma-pet-ct-for-detecting-prostate-cancer-recurrence-post-high-intensity-focused-ultrasound-and-brachytherapy-a-single-center-retrospective-study/

Summary

Andrea Di Giorgio, MD, Nuclear Medicine Resident, University of Bologna, Italy, presents results from a single-center retrospective study evaluating the role of 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) in men undergoing focal therapies for localized prostate cancer. He noted that focal therapies such as high-intensity focused ultrasound (HIFU) and brachytherapy are increasingly used in low- and intermediate-risk disease due to reduced side effects compared to radical prostatectomy or radiotherapy. However, follow-up and recurrence detection remain challenging. Conventional approaches, such as prostate-specific antigen (PSA) measurement, multiparametric magnetic resonance imaging (MRI), and repeat biopsy, each have limitations in accuracy or patient acceptability.

Dr. Di Giorgio reviews prior studies that explored fluorine-18 and gallium-68–labeled tracers with PET/MRI, showing promising results. Building on this, his group analyzed 22 patients with suspected biochemical recurrence after focal therapy. Seven had undergone HIFU and 15 brachytherapy, with a median PSA of 2.8 ng/mL at the time of PET imaging. The 68Ga-PSMA PET/CT identified recurrence in 14 of 22 patients, including local recurrences, lymph node involvement, and distant metastases. Clinical examples illustrated both nodal detection after brachytherapy and intraprostatic recurrence after HIFU, with subsequent confirmatory biopsy in selected cases. The median follow-up was 55 months, during which re-biopsy confirmed carcinoma in four patients. 

Dr. Di Giorgio argues that 68Ga-PSMA PET/CT may represent a sensitive, cost-effective, and more accessible alternative to PET/MRI for monitoring recurrence in patients treated with focal therapies, particularly when other modalities are inconclusive.

The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical cases and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.