Would you recommend biopsy of a bone met noted on PSMA PET after definitive prostate radiation?

There is no simple answer to this. The following are some relevant considerations:

• What was the original risk category? What was the Gleason score?
• What was the pre-treatment workup? Was there anything noted there previously?
• Was or is the patient on ADT?
• Pre-treatment and current PSA values?
• How long has it been since radiation?
• Size of the lesion? SUV? Are there any others, or is it a solitary lesion?
• Location of the lesion? (Challenging or risky location to biopsy?)

The above affects the in...

I presume that the patient was treated for localized prostate cancer. Then had some appropriate interval of decrease in PSA. And now has developed biochemical recurrence (per Phoenix definition) which prompted a PSMA PET/CT. For the basis of argument, I will assume that there is one location that is PET Avid, in the bone.

I agree with Dr. @Dr. First Last's overall recommendations that the intimate factors at initial diagnosis will assist with risk stratifying.

A biopsy is not unreasonable.

Anot...