Jack Andrews, Fellowship-Trained Urologic Oncologist and Surgeon-Scientist at the Mayo Clinic, shared on X:
“Prostate cancer paper of the day.
PRIMARY2 (Lancet Oncol, June 2026): Can PSMA PET spare biopsy after PI-RADS 2/3 MRI?
Buteau, Emmett et al. Phase 3, n=660, biopsy-naive, PSA ≤20, ≤cT2 PI-RADS 2 with high clinical risk, or PI-RADS 3
Ga-PSMA-11 PET pathway (PRIMARY score) vs systematic TP biopsy csPCa (GG2 with ≥10% pattern 4 or higher): 12% vs 16% (noninferior, difference −3.7%) Biopsy avoided in 49% (163/331) Insignificant PCa: 14% vs 32%
Takeaway: In the mpMRI gray zone, a PRIMARY-score directed PSMA PET strategy roughly halves biopsies and cuts insignificant cancer diagnoses, without compromising detection of clinically significant disease.
Caveat: Australian multicenter trial. MRI not centrally reviewed. Longer follow-up for delayed misses still matters, and access/cost will shape uptake.
For men with PI-RADS 2/3 and ongoing clinical concern, would you add PSMA PET before systematic biopsy, or is shared decision after mpMRI still enough in your practice?”
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