Table 2 Management of patients with a discrepant response on PET/CT and their biochemical assessment
Patient | Indication for first PET/CT | Findings on first PET/CT | Treatment between PET/CTs | Findings on second PET/CT | PET/CT response | Biochemical response | Management and outcome |
|---|---|---|---|---|---|---|---|
1 | Staging | Prostatic lesion, metastatic disease to bone and liver | Hormonal | Improvement in bone and liver disease, stable disease in the prostate | ↓ | ↑ | Continued same hormonal therapy |
2 | BF | Prostatic lesion, pelvic nodal involvement | Hormonal + radiation therapy to prostate and lymph nodes | NED | ↓ | ↔ | Continued same hormonal therapy, with further biochemical improvement |
3 | BF | Prostatic lesion seminal vesicles, pelvic lymph nodes, and bone | Hormonal | Stable disease in the prostate, seminal vesicles and lymph nodes, more extensive bone disease | ↑ | ↔ | Referred to LU177-PSMA |
4 | BF | Pelvic nodal disease | SBRT to lymph nodes | NED | ↓ | ↔ | Surveillance only |
5 | BF | Prostatic lesion, lymph nodes, lung and bone | Hormonal + chemotherapy | More extensive uptake in the prostate, enlargement of involved lymph nodes, lung mets, heterogeneous response in bone with new bony mets | ↑ | ↔ | Palliative radiation therapy and abiraterone |
6 | BF | Prostatic and rib lesions | Hormonal + SBRT to a rib | Stable disease in the prostate, no uptake in rib | ↓ | ↔ | Radiation to the prostate, hormonal therapy with temporary remission |
7 | BF | Prostatic lesion, involved pelvic lymph nodes and bone metastases | Hormonal + SBRT to L2 + XOFIGO | Stable disease in the prostate and lymph nodes, progression in known bone mets. L2 needed special attention | ↑ | ↓ | SBRT to L2 vertebra |
8 | BF | Involved pelvic lymph node | SBRT to LN | NED | ↓ | ↔ | Surveillance only |
9 | BF | Involved lymph nodes and bone mets | Hormonal | Reduction in size of nodes and decreased in uptake of bone mets | ↓ | ↔ | Continued same hormonal therapy with further biochemical improvement |
10 | BF | Involved retroperitoneal lymph node | SBRT to lymph node | Finding unchanged | ↔ | ↑ | Surveillance only on follow up PET/CT disease progression |
11 | BF | Prostatic lesion, seminal vesicles, pelvic lymph nodes and bone mets | Hormonal | Stable disease in the prostate and seminal vesicles, Increase in size of one involved lymph node and more extensive bone disease | ↑ | ↔ | Continued same hormonal therapy. Progression on follow-up PET/CT |