Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?  

I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...

Yes, if covered by insurance. 

It bears mentioning that the only high quality clinical trial demonstrating that the information obtained via PET changes clinical outcomes is the EMPIRE study, showing improved biochemical control for patients receiving an Axumin PET-CT prior to treatment as opposed to conventional imaging. While P...

Almost always. I run the patient's characteristics through the UCLA PSMA PET upstaging risk calculator. My cut-off is 10%, that is, if the likelihood that the PSMA PET scan will upstage 1 or more times for every 10 scans ordered when compared to CT/bone scan, I will order it. For example, for a PSA ...

I think the answer here is in "high and very high-risk patients" as suggested by Dr. @Geoff Sonn. Although I suspect that the data may soon arrive given the great interest in these more accurate tests, the use of PSMA PET-CT has not been effectively studied and peer-reviewed for patients treated in ...

Whenever covered by insurance. Unfortunately, the guidelines are woefully behind in recommendations. It will become a standard component of staging. Of note, after a visit to Tata Memorial in India, I learned that almost all patients get one. Many get them post treatment, as well. This is simply ...