How to cite: Collins, Sean P. “Can PSMA-PET Improve Outcomes in Prostate Cancer?” November 2025. Accessed Nov 2025. https://grandroundsinurology.com/can-psma-pet-improve-outcomes-in-prostate-cancer/
E. David Crawford, MD, Editor in Chief of Grand Rounds in Urology and Professor of Urology, University of California, San Diego, San Diego, California, introduces Sean P. Collins, MD, PhD, Professor of Radiation Oncology, University of South Florida, Tampa, Florida. Dr. Collins describes how Prostate Specific Membrane Antigen Positron Emission Tomography (PSMA PET) imaging may alter salvage radiation strategy for men with biochemical recurrence after radical prostatectomy.
Dr. Collins presents a case of a sixty-nine-year-old man with a rising prostate-specific antigen (PSA) level of 0.3 ng/mL. The PSMA PET scan shows an involved left pelvic lymph node and a left perirectal lymph node. Dr. Collins explains that these findings allow clinicians to modify standard prostatic fossa radiation fields, incorporate pelvic nodal radiation when appropriate, expand posterior margins, and intensify dose to PET-positive lymph nodes.
He reviews a phase two randomized clinical trial published in JAMA Oncology that evaluates PSMA-guided intensification of salvage radiation after prostatectomy. The study randomizes 130 men to either standard salvage radiation or PSMA-guided intensified salvage radiation. Median PSA at enrollment is 0.3 ng/mL.
After a median follow-up of 37 months, failure-free survival improves from 69% with standard salvage radiation to 84% with PSMA-guided intensification. The hazard ratio is 0.46.
The benefit is most significant in men with PSA levels of at least 0.2. Toxicity does not increase despite the use of broader fields and dose escalation. A phase three trial is needed to determine whether improved failure-free survival leads to improved overall survival.
ABOUT THE AUTHOR
Sean P. Collins, MD, PhD, is a Professor of Radiation Oncology and the Vice Chair of Faculty Affairs at the University of South Florida Morsani College of Medicine. In July 2006, Dr. Collins joined his twin brother Brian on the faculty of the Cancer Center at Georgetown University Hospital as an Attending Physician in Radiation Oncology. Dr. Collins graduated from the Medical Scientist Training Program (MSTP) at the University of Michigan in 2001. Professor Collins completed both an internship in Surgery and a residency in Radiation Oncology at Georgetown University Hospital. His area of expertise is prostate cancer, for which he treats patients using the CyberKnife®, a technology that allows for more accurate targeting of radiation therapy. Dr. Collins is a physician-scientist, and his work focuses on developing prostate cancer treatment protocols using stereotactic body radiation therapy (SBRT) to minimize the toxicity of radiation dose escalation. To date, he has treated over 2500 prostate cancer patients with SBRT and has presented his work at major meetings and published multiple papers on his experience in peer reviewed journals.
