3
Treatment
Newly Diagnosed Clinically High-Risk/Very High-Risk Localized
Prostate Cancer
Conventional imaging negative
➤ Recommendation 4.1. When conventional imaging is negative,
next generation imaging may be offered to patients for potential
detection of sites of disease amenable for treatment, although
prospective data are limited. (Moderate Recommendation; IC-U-W).
Conventional imaging suspicious/equivocal
➤ Recommendation 4.2. When conventional imaging is suspicious
or equivocal, NGI may be offered to patients for clarification of
equivocal findings or detection of additional sites of disease which
could potentially alter management, although prospective data are
limited. (Moderate Recommendation; IC-U-L).
Rising PSA after prostatectomy and negative conventional imaging
(either initial PSA undetectable with subsequent rise or PSA never
nadirs to undetectable)
➤ Recommendation 4.3. For men that are not candidates or are
unwilling to receive salvage local or regional therapy, additional NGI
should not be offered. (Moderate Recommendation; IC-U-L).
➤ Recommendation 4.4. For men for whom salvage radiotherapy
is contemplated, NGI should be offered (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) since they have superior
disease detection performance characteristics and may alter patient
management (Strong Recommendation; EB-B-H).
Rising PSA after radiotherapy and negative conventional imaging
➤ Recommendation 4.5. For men in whom salvage local or regional
therapy is not planned or is inappropriate, there is little evidence
that NGI will alter treatment or prognosis. The role of NGI in this
scenario is unclear and should not be offered, except in the context
of an IRB (Institutional Review Board) approved clinical trial.
(Moderate Recommendation; IC-U-I).