Table 2.
Unexpected PSMA PET-CT findings contemporaneously documented to alter the referring urologist’s preference regarding surgical management
| Case No. | Pre-PET TNM Stage | Urologist’s Pre-PET Preference To Offer Surgery | Post-PET TNM Stage | Unexpected PET Finding | Treatment Performed |
|---|---|---|---|---|---|
| 1 | M1a (para-aortic lymph nodes) | Decline | N0 M0 | No lymph node PSMA uptake | RP-PLND |
| 2 | N0 M0 | Offer | N1M1a | Non-regional lymph node metastases (extending above diaphragm) | Systemic therapy |
| 3 | T3M1b (lumbar spine and iliac bone) | Decline | N0 M0 | No bony PSMA uptake | RP-PLND |
| 4 | T3 N0 M0 | Offer | N1 M0 | Presacral and internal iliac lymph node metastases | Whole pelvis radiotherapy and hormone therapy |
| 5 | T3aN0 M0 | Offer | N0 M1 | Solitary vertebral metastasis | Whole pelvis radiotherapy, hormone therapy, stereotactic radiotherapy to metastatic deposit |
| 6 | T3aN0 M0 | Offer | N1 M0 | Presacral and internal iliac lymph node metastases | Whole pelvis radiotherapy and hormone therapy |
| 7 | T2cN0 M0 | Offer | N1M1b | Non-regional lymph node and bony metastases | Systemic therapy |
| 8 | T1 N0 M0 | Offer | N1, possible M1b | Local lymph node metastases and possible iliac bone PSMA uptake | Whole pelvis radiotherapy and hormone therapy |
| 9 | T3 N1 M0 | Offer | N1M1b | Non-regional lymph nodes and multiple bony metastases | Hormone therapy |
| 10 | T2cN0 M0 | Offer | N1M1b | Non-regional lymph nodes and bony metastases | Hormone therapy |
| 11 | T3 N0 M0 | Offer | N1M1a | Non-regional lymph node metastases | Hormone therapy |
RP-RPLND Radical prostatectomy with pelvic lymph node dissection