Nevertheless, many recent studies have shown its potential to detect metastatic disease in patients with intermediate- and high-risk prostate cancer undergoing pretreatment assessment, and it has recently received approval from the FDA for both recurrent and primary staging settings [117,119-121]. PSMA PET/CT examination has higher diagnostic performance for prostate cancer compared to fluciclovine PET/CT, which was able to identify additional patients with distant metastasis when compared to conventional imaging (bone scan and CT) in patients with intermediate- and high-risk disease. In a study of 130 patients with intermediate- and high-risk patients, PSMA PET demonstrated superior sensitivity and a similar specificity to morphological imaging alone (CT or MRI) [121]: 68.3% and 99.1%, respectively, for PSMA PET and 27.3% and 97.1%, respectively, for morphological imaging. Additionally, PSMA PET, especially when combined with MRI, can potentially improve detection and characterization (eg, assessment of local extent) of the primary tumor, by using different types of PSMA-targeted radiotracers, compared with multiparametric MRI alone or clinical nomograms [19,122,123]. TRUS Prostate TRUS is unlikely to provide useful incremental information in patients with an established diagnosis of intermediate-risk prostate cancer and so it is not beneficial. TRUS-Guided Biopsy Prostate Active surveillance may be beneficial in carefully selected patients with intermediate-risk prostate cancer [109- 111]. In that setting, some form of serial TRUS-guided biopsy would be useful as part of the monitoring regimen. Choline PET/CT Skull Base to Mid-Thigh Although choline PET/CT is primarily used in the recurrent setting, it can also be considered in the pretreatment assessment of prostate cancer based on its ability to better detect nodal and distant metastases than CT and bone scan.
Pretreatment Detection Surveillance and Staging of Prostate Cancer. Nevertheless, many recent studies have shown its potential to detect metastatic disease in patients with intermediate- and high-risk prostate cancer undergoing pretreatment assessment, and it has recently received approval from the FDA for both recurrent and primary staging settings [117,119-121]. PSMA PET/CT examination has higher diagnostic performance for prostate cancer compared to fluciclovine PET/CT, which was able to identify additional patients with distant metastasis when compared to conventional imaging (bone scan and CT) in patients with intermediate- and high-risk disease. In a study of 130 patients with intermediate- and high-risk patients, PSMA PET demonstrated superior sensitivity and a similar specificity to morphological imaging alone (CT or MRI) [121]: 68.3% and 99.1%, respectively, for PSMA PET and 27.3% and 97.1%, respectively, for morphological imaging. Additionally, PSMA PET, especially when combined with MRI, can potentially improve detection and characterization (eg, assessment of local extent) of the primary tumor, by using different types of PSMA-targeted radiotracers, compared with multiparametric MRI alone or clinical nomograms [19,122,123]. TRUS Prostate TRUS is unlikely to provide useful incremental information in patients with an established diagnosis of intermediate-risk prostate cancer and so it is not beneficial. TRUS-Guided Biopsy Prostate Active surveillance may be beneficial in carefully selected patients with intermediate-risk prostate cancer [109- 111]. In that setting, some form of serial TRUS-guided biopsy would be useful as part of the monitoring regimen. Choline PET/CT Skull Base to Mid-Thigh Although choline PET/CT is primarily used in the recurrent setting, it can also be considered in the pretreatment assessment of prostate cancer based on its ability to better detect nodal and distant metastases than CT and bone scan.