Surekha Yadav, a resident radiologist at the University of California, San Francisco, has helped uncover something that changes how doctors should think about detecting prostate cancer's spread to bone. Over the past two decades, conventional bone and CT scans have been the standard tools for identifying whether cancer has metastasized—yet they were missing something critical. A new study presented at the Society of Nuclear Medicine and Molecular Imaging 2026 Annual Meeting reveals that PSMA PET imaging, a newer nuclear medicine technique, detects bone metastases that conventional imaging overlooks entirely, with profound consequences for patient survival and treatment decisions.
The stakes are clinical and personal. Prostate cancer commonly spreads to bone, and for decades physicians relied on bone scans and CT scans to catch this spread. These tools have real limitations: they frequently miss small deposits of cancer already present and already reshaping a patient's prognosis. PSMA PET scans use a radioactive tracer that attaches directly to a protein found on prostate cancer cells, making them far more sensitive than conventional imaging. That superior sensitivity has made PSMA PET the gold standard for staging prostate cancer at major cancer centers.
The research itself is sobering. A retrospective study followed 36 patients across two academic centers—UC San Francisco and UC Los Angeles—who had between one and five bone lesions detected on PSMA PET at initial diagnosis. More than 80 percent of these patients had completely normal conventional imaging, despite harboring metastatic disease visible on the newer scan. When researchers compared outcomes against a larger cohort of 984 patients with no bone metastases on PSMA PET, the differences were stark: patients with even one to five bone lesions detected by PSMA PET had more than five times the risk of progressing to treatment-resistant cancer and nearly four times the risk of death over a median follow-up of 25 months.
The implications are immediate and urgent. When conventional imaging appears negative, oncologists often treat patients with less intensive therapy, as though their cancer hasn't spread. But Yadav's research shows that patients with bone metastases detected only by PSMA PET are not in a gray zone. Their cancer behaves aggressively, progresses faster, and carries graver outcomes. Many are currently being managed based on a bone scan that says everything looks fine—when in fact their disease trajectory has already changed.
What makes this finding actionable is that PSMA PET is not some distant future technology. The scan is already FDA-approved and available now at major academic cancer centers including UCSF and UCLA. According to Yadav, the bottleneck is not access but translation. "Until now, oncologists have had limited outcome data to guide how aggressively to treat patients whose PSMA PET finds bone metastases that conventional imaging misses. Our study provides that evidence." The research doesn't expand availability—it answers the question that kept clinicians hesitant: what should they actually do with results showing bone metastases that older scans would have missed?
This is the kind of discovery that works quietly but decisively. It doesn't require new drugs or complex new procedures. It simply asks that doctors act on better information when they have it, making treatment decisions that match the actual aggressiveness of the disease they're confronting.