Treatment
➤ 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).
