4
➤ Recommendation 4.6. For men for whom salvage local or regional
therapy (e.g., salvage prostatectomy, salvage ablative therapy,
or salvage lymphadenectomy) is contemplated, there is evidence
supporting NGI for detection of local and/or distant sites of
disease. Findings on NGI could guide management in this setting
(e.g., salvage local, systemic or targeted treatment of metastatic
disease, combined local and metastatic therapy). PSMA imaging
(where available), C-11 choline or F-18 fluciclovine PET/CT or
PET/MRI, whole body MRI and/or F-18 NaF PET/CT have superior
disease detection performance characteristics compared to
conventional imaging and alter patient management, although data
are limited (Moderate Recommendation; EB-B-I).
Metastatic prostate cancer at initial diagnosis or after initial
treatment, hormone sensitive
➤ Recommendation 4.7. In the initial evaluation of men presenting
with hormone-sensitive disease with demonstrable metastatic
disease on conventional imaging, there is a potential role for NGI
to clarify the burden of disease and potentially shift the treatment
intent from multimodality management of oligometastatic disease
to systemic anti-cancer therapy alone or in combination with
targeted therapy for palliative purposes, but prospective data are
limited (Moderate Recommendation; IC-U-I).
Non-metastatic CRPC (nmCRCP)
➤ Recommendation 4.8. For men with nmCRPC, NGI can be offered
only if a change in the clinical care is contemplated. Assuming
patients have received or are ineligible for local salvage treatment
options, NGI may clarify the presence or absence of metastatic
disease, but the data on detection capabilities of NGI in this
setting and impact on management are limited (Moderate
Recommendation; IC-U-L).
Treatment
