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How do you interpret nodes with minimal increased uptake on PSMA PET in prostate cancer?
In the recently published SPARC grading scale for PSMA PET, equivocal nodes on PSMA PET are classified as:
- Low uptake (equal to or lower than the blood pool) in a site typical for prostate cancer, or
- Intermediate to high uptake (equal to or lower than parotid gland and higher than liver, or higher than parotid) in a site atypical for prostate cancer.
At our facility, IR usually is not able to biopsy these nodes when they're small.
Do you use a similar grading scale? Do you attempt to biopsy nodes typically?
What SUV parameters do you use to decide if treatment is warranted for node-positive disease?
Radiation Oncologist
This question is relatively similar to another recent question on indeterminate PSMA PET (#26360), where I provided a longer answer in a bit more detail. The summary is that this essentially relies upon your clinical judgement, and there is no definitive algorithmic way to determine the true nature ...
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