Does a negative staging PSMA PET in a patient with biopsy-proven recurrent prostatic adenocarcinoma change your management?

I have a pair of patients with MRI+ and biopsy+ disease who have staging PSMA PET/CT that do not show disease within the prostate (or anywhere else). Do we think this tells us something about the biology of the disease?

Answer from: Radiation Oncologist at Academic Institution

The bottom line is that you have to believe the biopsy. PSMA PET will not show microscopic disease, which is why it cannot "rule out" disease in lymph nodes or elsewhere. It is comforting when it is negative, but it is not absolute truth. A few questions; What was the PSA at the time of the PSMA PE...

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Radiation Oncologist at Cooper University Hospital
Thank you Dr. @Crook. I think I did a poor job wri...

Radiation Oncologist at National Institutes of Health Clinical Center
I think some tumors just lack PSMA expression, and...

Answer from: Radiation Oncologist at Community Practice

The concordance between PET and MRI for recurrence is about 50%. Valle et al., Journal of Clinical Oncology 2023

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Does a negative staging PSMA PET in a patient with biopsy-proven recurrent prostatic adenocarcinoma change your management?

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