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Topics:
Radiation Oncology • Genitourinary Cancers
How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?
What sort of factors (post-op PSA level, time to biochemical failure, Gleason score, etc.) help guide your decision making?
In general, when do you consider elective nodal coverage and/or use of ADT?
What ADT is used, and for how long?
Answer from: Radiation Oncologist at Academic Institution
It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, includ...
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Answer from: Radiation Oncologist at Academic Institution
A negative PSMA does not change my treatment recommendation. I use a mix of PSA and pre-op factors to decide whether I recommend elective nodal irradiation (ENI), along with a fair amount of shared decision making (SDM) with the patient and at times with Urology (who administer ADT but not NHT at my...
Answer from: Radiation Oncologist at Community Practice
I would consider ENI and 24 months ADT for PSA > .5, GS 8 and above, or a high decipher score.