Reference: 2026 | Issue 7 | Vol 12 | Page 42
A prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) imaging test could safely halve the number of people who need a biopsy for suspected prostate cancer following inconclusive or reassuring results from an MRI scan, new research has found. Findings from the PRIMARY2 trial were presented at the 2026 European Association of Urology Congress by Dr James Buteau, a nuclear medicine physician at Peter MacCallum Cancer Centre, Melbourne, Australia.
The PRIMARY2 trial recruited people at higher risk of prostate cancer, such as a strong family history, who had a normal result on their MRI. These people often go ahead with prostate biopsy. They were randomly assigned to have either a standard biopsy or a PSMA PET/CT scan.
PSMA PET/CT scanning could identify people who either did not have cancer, or whose cancer was so low-risk or slow-growing, it would likely never cause harm. These people did not need a biopsy. Meanwhile, people with a positive PSMA PET/CT scan result had a biopsy. This approach halved the number of people who needed a biopsy, without missing any harmful cancers. For patients who still needed a biopsy, their scan results ensured the procedure was targeted to the suspicious areas identified in the test to minimise complications and improve accuracy.
These are the first results released from PRIMARY2, which will follow these 660 patients for two years. PRIMARY2 is an Australia-wide phase III clinical trial, led from Peter MacCallum Cancer Centre in Melbourne and St Vincent’s Hospital in Sydney. PSMA PET/CT scanning is becoming increasingly accessible in the UK and Europe, primarily for diagnosing high-risk or recurrent prostate cancer, although cost and availability remain limitations to widespread use. It is widely available in Australia.
Dr Buteau said: “PSMA PET/CT scanning makes prostate cancer cells light up in a remarkable way, particularly in more aggressive cancers. It’s rare to see such strong imaging that could be so powerful in the clinic. Incorporating this testing into clinical care could help to address the major challenge of prostate cancer overdiagnosis, which leads to, at best unnecessary, and at worst harmful, treatment for cancers that would never cause any harm.”
