(UroToday.com) The 2025 South Central AUA annual meeting included a session on prostate cancer, featuring a presentation from Dr. Ramses Rosas discussing SUVmax overexpression in PSMA PET/CT and the association with aggressiveness according to ISUP score. Prostate cancer is the second most common cancer in men worldwide and the fifth leading cause of cancer-related mortality. The ISUP grading system and PSA levels are standard methods for assessing tumor aggressiveness. Of note, PSMA PET/CT studies have shown that tumors with high ISUP grades exhibit increased radiotracer uptake, indicating added aggressiveness.
This was a descriptive, observational, and retrospective study of patients who underwent radical prostatectomy and PSMA PET/CT for staging between October 2019 and May 2024. The objective of the study was to determine the relationship between PSMA PET/CT uptake (SUVmax) and ISUP grade in prostate cancer patients undergoing radical prostatectomy.
A total of 78 patients were analyzed, with a mean age of 64.9 years and a mean PSA level of 16.41 ng/dL. Preoperative SUVmax was calculated and correlated with postoperative ISUP grade from the pathological specimen. The Pearson correlation coefficient between ISUP grade and SUVmax was 0.017, indicating a positive linear relationship. The chi-square test showed a Chi² value of 18.86 and a p-value of 0.042 (p < 0.05), demonstrating a significant relationship between SUVmax in the seminal vesicles and ISUP grade. Patients with higher SUVmax values had a mean ISUP score of 4.8, compared to 2.5 in those with lower SUVmax:
The following shows the percentage distribution of ISUP scores by SUVmax category:
Clinically, this suggests that higher SUVmax correlates with higher ISUP scores, indicating a potential association between metabolic activity in the seminal vesicles and tumor aggressiveness. Various imaging techniques and biomarkers, including dynamic contrast imaging, PSMA PET/CT, PSA levels, and PSA density, have been evaluated for predicting ISUP grade. PSMA PET/CT demonstrated a strong correlation with ISUP grade, particularly in high-grade tumors, with superior sensitivity and specificity.
Dr. Rosas concluded this presentation discussing SUVmax overexpression in PSMA PET/CT and the association with aggressiveness according to ISUP score in prostate cancer with the following take home points:
- PSMA PET/CT in radical prostatectomy patients provides valuable prognostic insight into tumor aggressiveness based on metabolic activity
- A low ISUP score may sometimes present with high SUVmax, potentially delaying diagnosis and treatment planning
Presented by: Ramses Rosas, Division de Urologia, Hospital General Dr. Manuel Gea Gonzalez, Ciudad de Mexico, Mexico City, Mexico
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 South Central American Urological Association (AUA) Annual Meeting, Orlando, FL, Wed, Sept 10 – Sat, Sept 13, 2025.