Science

Siddharth Sreemahadevan: PSMA PET/CT in Staging of Prostate Cancer – Gamechanger or Hype?

Siddharth Sreemahadevan/LinkedIn

Sep 4, 2025, 12:51

Siddharth Sreemahadevan: PSMA PET/CT in Staging of Prostate Cancer – Gamechanger or Hype?

Siddharth Sreemahadevan, Medical Oncologist at Regional Cancer Centre Thiruvananthapuram, shared on LinkedIn:

”PSMA PET/CT in Staging of Prostate Cancer – Gamechanger or Hype?

This week, I had the opportunity to represent the “Gamechanger” side in an academic debate on one of the hottest topics in oncology imaging: PSMA PET/CT for primary staging of prostate cancer.

With a mix of hard evidence and a little humor, I argued why PSMA PET/CT is not just another incremental advance but a true paradigm shift.

Key points I highlighted:

Superior accuracy: proPSMA trial showed 92% accuracy vs 65% with conventional imaging (CT + bone scan).

Management impact: Changed treatment intent in ~27% of cases — sparing patients from futile radical surgery and enabling early systemic/targeted therapies.

One-stop whole-body staging: Detects LN, bone, and visceral mets in a single scan, reducing time, radiation, and uncertainty.

Guideline support: NCCN 2025 and SNMMI now recommend PSMA PET/CT as first-line imaging in high-risk disease.

Future-ready: Combination with mpMRI, cost-effectiveness, expanding tracer availability, and integration with theranostics.

And of course, I tackled the usual critiques:

‘No OS benefit yet’ – true, but management changes today will drive outcomes tomorrow.
‘False positives’ – less common than conventional scans, with ~98% specificity.
‘Stage migration hype’ – it actually prevents overtreatment and opens the door to metastasis-directed therapy.

What I enjoyed most was making the session not just data-heavy but also engaging — because sometimes a smile helps the science stick.

Grateful to my mentors, colleagues, and the audience for the interactive discussion. This debate reminded me that the best way to argue science is to blend rigorous evidence with clear, relatable communication.

Take-home: PSMA PET/CT doesn’t just detect more disease — it detects the right disease, at the right time, guiding the right treatment. That’s the definition of a gamechanger.”

Siddharth Sreemahadevan