How do you reconcile discordant PSMA and MRI findings in patients undergoing definitive radiotherapy for prostate cancer?

In the situation wherein you found something on PSMA PET that wasn’t seen on MRI, I would obtain a biopsy for 2 reasons: 1. In order to confirm the presence of distant metastasis or 2. If tissue is needed for genomic testing. Otherwise, I would not biopsy in the case of discordant imaging, since I w...

I agree with Dr. @Dr. First Last's general approach. Pertaining to SVI specifically, a few additional points which could be considered.

1. Pre-test probability: I usually try to review the imaging for new consults twice, first blinded to clinical features and second in context of the clinical features....

I usually cover the proximal 1 cm of the seminal vesicles in my "prostate" volume anyway, so if there was PSMA uptake in the more distal SV, it generally wouldn't make a much larger volume to treat all of the SVs as well, which is what I'd most likely do if the patient was in front of me today.

It w...