How to cite: Vargas A. “What Type of Scanning Should Be Done in High-Risk Patients?” Patients? Grand Rounds in Urology. October 23, 2025. Accessed Oct 2026. https://grandroundsinurology.com/what-type-of-scanning-should-be-done-in-high-risk-patients/
Summary
Alberto Vargas, MD, Vice Chair of Oncologic Imaging and Strategy, Professor, Department of Radiology, New York University, New York, New York, addresses contemporary imaging strategies for high-risk prostate cancer patients, emphasizing the shift away from conventional imaging toward prostate-specific membrane antigen positron emission tomography (PSMA PET)-computed tomography (CT). Dr. Vargas reviews the historical use of bone scan and CT, outlining their well-recognized limitations, including low sensitivity for osseous disease and poor morphologic assessment of lymph nodes. These limitations render conventional imaging outdated for most high-risk clinical scenarios.
Dr. Vargas reviews the biological basis of PSMA, specifically the targeting of the extracellular domain for effective imaging. He highlights that PSMA expression is not exclusive to prostate cancer, noting that uptake in other malignancies and benign conditions must be considered during interpretation.
Dr. Vargas summarizes evidence supporting PSMA PET-CT, including randomized data demonstrating superior diagnostic accuracy compared with conventional imaging and a substantial impact on clinical management.
Dr. Vargas explores the role of PSMA PET-CT in primary tumor assessment. Data demonstrates diagnostic performance comparable to multiparametric magnetic resonance imaging (MRI) and improved inter-reader agreement, however, MRI remains essential for its superior anatomic resolution, particularly for evaluating zonal anatomy and features of extraprostatic extension.
Dr. Vargas addresses the critical discussion of reporting variability across institutions, emphasizing the need for standardized PSMA PET-CT reporting to fully realize the modality’s clinical value.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Alberto Vargas, MD, is Vice Chair of Oncology Imaging and Strategy, and a Professor within the Department of Radiology at New York University in New York City. Dr. Vargas specializes in oncological and molecular imaging. His clinical and research interests focus on the use of advanced-imaging modalities, including diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging and novel positron emission tomography tracers for the non-invasive diagnosis, staging, treatment response assessment, and follow-up of patients with cancer. Dr. Vargas is especially interested in imaging patients with cancers involving the urinary system and the female reproductive organs.
