"PSMA-PET guided SBRT for oligo-metachronous PCa recurrence in appropriately triaged patients results in excellent local control, low toxicity and over 50% ADT free at 5 years."
See "Long-term outcomes of SBRT for PSMA PET detected oligometastatic prostate cancer"
ro-journal.biomedcentral.co...
“If PSMA PET–CT imaging is positive without conventional correlates that would have
been independently seen on CT or [99mTc]Tc-MTD bone scintigraphy, there may be a knee
jerk reaction to label them as metastatic in the conventional sense. Then clinicians will be
considering agents approved in the metastatic castration sensitive prostate cancer (mCSPC)
such as docetaxel, apalutamide, enzalutamide, or abiraterone.
Understanding the natural history of BCR based on existing data should be used to
inform clinicians about their management decisions in patients who have conventional
imaging devoid of metastatic disease despite PSMA scan findings.
However, if conventional imaging and PSMA PET–CT imaging results are conflicting, interpreting
these results with the knowledge of retrospective studies will be required until prospective
evidence is available to prevent overtreatment and optimize patient care. Upon reviewing
existing data, it becomes more evident that caution should be used when labeling PSMA
positive patients as equivalent to mCSPC and equating them to populations in mCSPC
trials, when it is very likely that the indolent nature of recurrent disease may not be as
impacted from treatment intensification of ADT-based combinations. Deploying such ADT
combinations earlier may have more ambiguous net benefits to patients when weighed
against the toxicity of such regimens which may need to be administered for a decade or
more in some cases.”
See "The Continuum of Metastatic Prostate Cancer: Interpreting PSMA PET Findings in Recurrent Prostate Cancer."