Treatment
Figure 1. Imaging Algorithm for High/Very High-Risk Disease
at Initial Presentation (per National Comprehensive
Cancer Network [NCCN])
High/very high-risk disease at initial
presentation (per NCCN)
Negative/
equivocal
Positive
conventional
imaging
Conventional imaging
(CT, BS, or mpMRI)
Consider NGI
a
(WBMRI,
18
F-NaF,
or
PSMA PET
b
)
No indication for
NGl
c
a
Suspicious findings on NGI would influence treatment decisions in patients with advanced
prostate cancer and negative conventional imaging, opening the scope for multimodality treatment
of primary and oligometastatic disease or systemic therapy for more extensive metastatic states,
although prospective data are limited.
b
ere is enthusiasm for the potential added value of PSMA PET/CT and PET/MRI for the
assessment of the local and metastatic extent of prostate cancer in this context, although PSMA
imaging is not currently FDA approved and should thus be only performed as part of a clinical trial
or other controlled research setting.
c
NGI could offer clinical benefit in this scenario by redefining the true extent of disease and shiing
treatment decisions accordingly, although prospective data in this context are limited.
