# proPSMA: PSMA PET-CT versus conventional imaging for staging high-risk prostate cancer

Source: https://onco.cc/key-papers/paper-propsma-hofman-lancet-2020/  
OnCo record `paper-propsma-hofman-lancet-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

PSMA PET-CT was 27 percentage points more accurate than CT and bone scan for finding spread in men with high-risk prostate cancer before treatment, with less radiation and more influence on management, and it has replaced conventional imaging where available.

## Summary

Randomised multicentre trial of 302 men with high-risk localised prostate cancer randomised to conventional imaging (CT and bone scan) or gallium-68 PSMA PET-CT for staging, with crossover imaging to define a reference standard.

Accuracy was 92 percent for PSMA PET-CT against 65 percent for conventional imaging, with higher sensitivity (85 versus 38 percent) and specificity, fewer equivocal results, lower radiation dose and more frequent management change.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet
- Year: 2020
- DOI: 10.1016/S0140-6736(20)30314-7
- Authors: Hofman MS, Lawrentschuk N, Francis RJ, et al.
- Findings: Accuracy 92 percent vs 65 percent (27 percent absolute difference).; Sensitivity 85 percent vs 38 percent; specificity 98 percent vs 91 percent.
- What it means: PSMA PET-CT is the preferred staging investigation for high-risk prostate cancer and for biochemical recurrence, though most treatment trials were designed with conventional imaging.
- Caveats: Reference standard relied partly on imaging follow-up rather than histology.; Detecting more disease does not by itself prove better outcomes.

## Sources

- Lancet 2020: https://doi.org/10.1016/S0140-6736(20)30314-7
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32209449/

## Connected records

- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- cancers: [Biochemical recurrence of prostate cancer](https://onco.cc/cancers/prostate-bcr/), [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [PET/CT](https://onco.cc/technologies/pet-ct/), [PSMA PET](https://onco.cc/technologies/psma-pet/)
- targets: [PSMA](https://onco.cc/targets/psma/)
- pathways: [Prostate cancer (KEGG map)](https://onco.cc/pathways/prostate-cancer-signalling/)
- terms: [Theranostics](https://onco.cc/terms/theranostics/)
- trials: [proPSMA](https://onco.cc/trials/propsma/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)
- biomarkers: [PSMA expression by PET (PSMA-positive)](https://onco.cc/biomarkers/psma-pet-expression/)

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