Would you offer prostate specific PET imaging (e.g. Axumin or PSMA PET) in a post-RT prostate cancer patient that has a rising PSA that has not yet met failure criteria?

Maitre et al., PMID 35189154

This study shows a high pick up rate with PSA not meeting failure criteria and many of them had focal relapses which are potentially salvageable.

Short answer is yes! This indication is now in the NCCN guidelines, which recommends PET restaging for suspicion of recurrence even when PSA rises have not yet reached the traditional PSA failure criteria for primary RP or RT.

The associated question is when… this is more nuanced to the case, as PS...

Yes, but at PSA levels <0.5ng/ml only about 1/3 of the scans will be positive. In these situations, I generally inform the patient that the scan is more likely to be negative than positive, so they're not surprised and frustrated by that result.

Yes