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How do you reconcile discordant PSMA and MRI findings in patients undergoing definitive radiotherapy for prostate cancer?
For example, if MRI revealed prostate-confined disease but PSMA had moderate avidity in the bilateral seminal vesicles, would you obtain further biopsies of discordant areas? Intensify therapies?
Answer from: Radiation Oncologist at Academic Institution
In the situation wherein you found something on PSMA PET that wasn’t seen on MRI, I would obtain a biopsy for 2 reasons: 1. In order to confirm the presence of distant metastasis or 2. If tissue is needed for genomic testing. Otherwise, I would not biopsy in the case of discordant imaging, sin...
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Answer from: Radiation Oncologist at Academic Institution
I agree with Dr. @Anscher's general approach. Pertaining to SVI specifically, a few additional points which could be considered.
Pre-test probability: I usually try to review the imaging for new consults twice, first blinded to clinical features and second in context of the clinical features. The f...
Answer from: Radiation Oncologist at Community Practice
I usually cover the proximal 1 cm of the seminal vesicles in my "prostate" volume anyway, so if there was PSMA uptake in the more distal SV, it generally wouldn't make a much larger volume to treat all of the SVs as well, which is what I'd most likely do if the patient was in front of me today.
It ...