Would you offer focal prostate boost per FLAME protocol for GTV defined by PET alone without MRI?  

I think there are two questions here: Can you use PSMA PET to define the boost target? Yes (with a little bit of caution). There have been several reports on the safety/feasibility of PSMA-based focal boost. Note, though, that FLAME was based on MRI, and we can expect that the PET-defined lesion ma...

Great discussion. If people are looking for further discussion, we recently reviewed this topic with the FLAME study team for PRO (Patel et al., PMID 39019208). Specifically, section II.C provides a brief comparison of PET/CT vs. MRI with a discussion of the possible false positives of PET/CT with c...

PSMA PET is actually not that specific within the prostate gland, as shown by Mookerji et al., PMID 38949926 (only 27% specific for tumor laterality compared to prostatectomy specimen). As I learned at the recent World Brachytherapy Congress, "All that lights up may not need to be dose-escalated."&n...