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).
