Prostate-specific membrane antigen (PSMA) PET was approved by the U.S. Food and Drug Administration in 2020 for the staging of newly diagnosed prostate cancer, yet rates of adoption and real-world positivity rates are unknown. We characterized patients undergoing PSMA PET staging and describe positive findings in a large national cohort. Methods: We identified all newly diagnosed prostate cancer patients in the national Veterans Health Administration from June 2020 to August 2023. Demographics, staging imaging reports, and cancer-related information were obtained from electronic medical record data. To assess positive findings, we chart-reviewed 1,994 patients (n = 657 low to intermediate risk) with staging PSMA PET reports available. Results: Among 31,838 patients with newly diagnosed prostate cancer, 4,538 (14%) underwent PSMA staging. Use of PSMA staging increased rapidly from near 0 in early 2021 to approximately 70% of patients with high- or very-high-risk disease by August 2023. Among patients who were N0/M0 by conventional imaging, PSMA PET positivity rates (N1 or M1) were 5.9% for favorable intermediate risk, 8.2% for unfavorable intermediate risk, 14% for high risk, and 34% for very high risk. Conclusion: PSMA PET staging for newly diagnosed prostate cancer increased rapidly in the Veterans Health Administration. Positivity rates were less than 10% in this large intermediate-risk cohort. These data confirm the utility of PSMA PET staging in high-risk disease and suggest that additional study is needed to refine patient selection in intermediate-risk disease.

前列腺特异性膜抗原 （PSMA） PET 于 2020 年被美国食品和药物管理局批准用于新诊断的前列腺癌的分期，但采用率和实际阳性率尚不清楚。我们表征了接受 PSMA PET 分期的患者，并在一个大型全国队列中描述了阳性发现。方法：我们从 2020 年 6 月至 2023 年 8 月在国家退伍军人健康管理局确定了所有新诊断的前列腺癌患者。人口统计学、分期影像学报告和癌症相关信息均来自电子病历数据。为了评估阳性结果，我们回顾了 1,994 名患者 （n = 657 名低至中度风险），并提供了分期 PSMA PET 报告。结果：在 31,838 名新诊断的前列腺癌患者中，4,538 名 （14%） 接受了 PSMA 分期。PSMA 分期的使用从 2021 年初的接近 0 迅速增加到 2023 年 8 月高危或极高危患者的约 70%。在常规影像学检查为 N0/M0 的患者中，PSMA PET 阳性率 （N1 或 M1） 为良好中等风险 5.9%，不良中等风险 8.2%，高风险 14%，极高风险 34%。结论：在退伍军人健康管理局，新诊断前列腺癌的 PSMA PET 分期迅速增加。在这个大型中等风险队列中，阳性率低于 10%。这些数据证实了 PSMA PET 分期在高危疾病中的实用性，并表明需要更多的研究来改进中危疾病的患者选择。