Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?

Topics: Radiation Oncology • Genitourinary Cancers • Prostate Cancer • Medical Oncology • NCI-CCC Tumor Board Question • UCSF • NCI-CCC GU Tumor Board Question

Gleason 4+3=7 and PSA 4

Answer from: Radiation Oncologist at Academic Institution

I would approach this scenario by considering two main issues. The first issue is what the probability of the patient truly having pN+ disease based on cN+ findings on advanced imaging. There have recently been two trials published from the Netherlands, PEPPER (using 68¸Ga-PSMA-11) and SA...

Answer from: Radiation Oncologist at Community Practice

This patient will clearly require adjuvant or salvage RT and one must question the value of RP with its attendant morbidities (especially if lymph node dissection). I've been treating the prostate and nodes since 2010 with combined radiation (EBRT/Pd-103) and ADT based on nanoparticle imaging (Combi...

Answer from: Medical Oncologist at Academic Institution

This is a current gray area in GU oncology, but based on the EMPIRE-1 study (Jani et al., PMID 33971152), fluciclovine PET-directed local therapy is likely associated with improved outcomes, at least with radiotherapy and ADT in the salvage post-RP setting. This suggests that PSMA PET directed thera...

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