How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?

What sort of factors (post-op PSA level, time to biochemical failure, Gleason score, etc.) help guide your decision making? In general, when do you consider elective nodal coverage and/or use of ADT? What ADT is used, and for how long?

3 Answers

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Radiation Oncology · Virginia Commonwealth University Medical Center

Answered on

It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including ot...

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Radiation Oncology · Vanderbilt-Ingram Cancer Center

Answered on · Updated on

A negative PSMA does not change my treatment recommendation. I use a mix of PSA and pre-op factors to decide whether I recommend elective nodal irradiation (ENI), along with a fair amount of shared decision making (SDM) with the patient and at times with Urology (who administer ADT but not NHT at my...

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Radiation Oncology · Varian Medical Systems/Allegheny health network

Answered on

I would consider ENI and 24 months ADT for PSA > .5, GS 8 and above, or a high decipher score.

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