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For a patient post-prostatectomy with a high PSA (>1), a negative MRI pelvis, and a negative PSMA PET scan, do you pursue any other imaging?

4 Answers

Mednet Member

Radiation Oncology · Varian Medical Systems/Allegheny health network

The sensitivity of PSMA scan for PSA above 1 is about 75-90%.

I would proceed with salvage RT plus ADT like we did in the era when PSMA was not available.

Mednet Member

Radiation Oncology · UC San Diego

It is disconcerting but happens. I ask my favorite radiology and nuc med friends to review it carefully. If still negative, I do not routinely order any additional imaging. Just proceed with salvage RT +/- ADT.

Mednet Member

Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty

This scenario fits PSA persistence/recurrence after radical prostatectomy which is defined as when PSA does not fall to undetectable levels (PSA persistence) or undetectable PSA after radical prostatectomy with a subsequent detectable PSA that increases on 2 or more determinations (PSA recurrence) o...

Mednet Member

Radiation Oncology · Coastal Radiation Oncology

I would need more information first. What was the pre-surgical PSA? What did the final pathology show in terms of Gleason grade? Might this be a neuroendocrine variant where PSA really doesn’t reflect the volume of disease? As part of the process, a CT of the abdomen and pelvis with IV contrast migh...