REVIEW ONCOLOGY

The accuracy of PSMA PET/CT for assessing intraprostatic lesions in patients with prostate cancer: An evaluation of the PI-RADS, PRIMARY and PSMA-expression score

SUMMARY

Background: Magnetic Resonance Imaging (MRI) is advised for the diagnosis of prostate cancer (PC), and PSMA PET/CT is used for distant staging of PC. Local staging of the primary tumour with PSMA PET/CT is currently not recommended, although the primary lesion can be visualised as well. Recently, two new tumour-assessing scores were developed to optimise the diagnostic accuracy of PSMA PET/CT for the primary tumour: the PSMA-expression score and the PRIMARY score.

Objective: To evaluate the performance of PSMA PET/CT and its PRIMARY and PSMA-expression scores in the assessment of intraprostatic lesions in patients with PC. Patients and methods: This is a retrospective analysis of patients treated with radical prostatectomy for PC in a single tertiary centre between 2019 and 2022. All patients underwent preoperative prostate MRI and 18F- or 68Ga-PSMA-11 PET/CT. The medical images were pseudonymized and retrospectively assessed by two radiologists and a nuclear medicine specialist. The PSMA PET/CTs were scored according to the PSMA-expression score (PROMISE V2 framework) and the PRIMARY score. The MRIs were scored using the PI-RADS system. The accuracy of the three different scores for diagnosing high-grade PC (ISUP grade ≥3) was evaluated.

Results: The PSMA-expression score demonstrated the highest accuracy for detecting high-grade PC, with an AUC of 0.76, outperforming the PI-RADS scores from reader 1 (AUC of 0.59) and reader 2 (AUC of 0.68) and the PRIMARY score (AUC of 0.69). It had a sensitivity of 72%, a specificity of 70%, a positive predictive value of 85%, and a negative predictive value of 51%.

Conclusion: PSMA PET/CT has a promising diagnostic accuracy to detect intraprostatic lesions of high grade in patients with PC. Further validation of the PSMA PET scoring systems is warranted.

Patient summary: In this study, the performance of PSMA PET/CT (the PRIMARY and PSMA-expression scores) to detect malignant lesions in the prostate was evaluated. PSMA PET/CT and these scoring systems seem promising to detect PC and could be of interest in cases where MRI is ambiguous.

(BELG J MED ONCOL 2025;19(2):46–53)

The development of a supporting tool for professionals for adequate referral of cancer patients to supportive care services in Belgium: The Belgian Handbook for (Haemato)-Oncological Supportive Care

SUMMARY

Supportive oncological care is essential for ensuring the quality of life of cancer patients and carers. In the long-term, adequate care for survivors can lead to less severe sequelae and reduced need for medical support. Despite the advances in cancer treatment leading to increased survival rates, not all patients in Belgium have equal access to supportive care. Key hindrances include the lack of legal and practice frameworks and insufficient knowledge of available services among patients and professionals. This paper discusses the development of a supporting tool for professionals to adequately refer patients to reliable and accessible supportive care services in Belgium: The Belgian Handbook for (Haemato)-Oncological Supportive Care. The methods used in the development process are presented and discussed with regard to achieving a useful and sustainable tool.

(BELG J MED ONCOL 2025;19(2): 54–60)

Admission of patients with solid cancer in the Intensive Care Unit: Challenging situations

SUMMARY

The proportion of cancer patients considered for admission in intensive care units (ICU) gradually increased over the last decades. In this situation, it is important to avoid inappropriate management, whether through refusal of admission that could be beneficial, or through futile therapeutic escalation. In this review, we describe the factors that medical oncologists and intensive carers should discuss when considering ICU admission for cancer patients and propose a framework for decision-making based on four important concepts. Among cancer patients, data strongly suggest that the short-term prognosis is more linked to the acute pathology than to the underlying active tumour. More specifically, the impairment of more than two vital organs and the requirement of organ support are the most important factors predictive of mortality. ECOG performance status furthermore remains a crucial prognostic factor to consider. Open discussions with patients and close relatives at cancer diagnosis and during treatment are mandatory for informed decision making during an acute event.

(BELG J MED ONCOL 2025;19(1): 4–10)

A concise and non-exhaustive overview of neurological complications in patients treated for solid tumours

SUMMARY

Neurological diseases occur more frequently in patients with active tumours and/or undergoing treatment for oncological disease. Malignancy-associated changes in cell signalling and biological processes occur, as well as “naturally occurring” and treatment-induced immune-related adverse events that can be both cell- or antibody-mediated. Prompt evaluation, timely accurate treatment, and interdisciplinary care are of paramount importance to prevent or diminish long-term neurological sequelae and mortality.

(BELG J MED ONCOL 2025;19(1):11–14)

Molecular oncology in non-small cell lung cancer: An update

SUMMARY

The introduction of targeted therapies has dramatically changed the outcome for patients with oncogenedriven non-small cell lung cancer. Recent advances have led to the introduction of targeted therapies in early-stage non-small cell lung cancer, as well as the development of new strategies to overcome resistance. The current manuscript gives an update on targeted therapies in oncogene-driven non-small cell lung cancer.

(BELG J MED ONCOL 2024;18(7):253–257)

Appropriateness and optimal sequence of treatments for metastatic castration-resistant prostate cancer: Outcomes of a Belgian and Dutch multidisciplinary consensus meeting

SUMMARY

The life expectancy and quality of life of patients with metastatic castration-resistant prostate cancer (mCRPC) continue to improve with the registration of new therapies. However, for individual patients, the appropriateness and optimal sequence of taxanes, radium-223, androgen receptor pathway inhibitors and lutetium-177-prostate-specific membrane antigen (PSMA) remains to be determined. To assess the current positioning of radium-223 and lutetium-177-PSMA as treatments for mCRPC, a consensus meeting with a multidisciplinary panel of experts from the Netherlands and Belgium was held. This article summarises the panel’s guidance on preferred sequences and the discussions of that meeting.

(BELG J MED ONCOL 2024;18(7):258–267)

Organ donation by cancer patients

SUMMARY

The need for organs for transplantation is growing, as is the incidence of people affected by cancer. Many cancer patients will be cured of their disease and might be eligible for organ transplantation. There is always a possibility for donor-transmitted cancer, and this is a potentially lethal condition. In this review, the factors that determine the eligibility of cancer patients as organ donors are discussed.

(BELG J MED ONCOL 2024;18(7):268–270)