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Table 2 Management of patients with a discrepant response on PET/CT and their biochemical assessment

From: [68Ga]Ga-PSMA-11 PET/CT for monitoring response to treatment in metastatic prostate cancer: is there any added value over standard follow-up?

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
  1. Response to treatment: ↓ improvement; ↑ progressive disease (PD); ↔ stable disease (SD)
  2. Abbreviations: SBRT stereotactic body radiation therapy, BF biochemical failure, NED no evidence of disease, mets metastases