Fig. 1.

Flow chart of initial prostate cancer staging and treatment planning in standard of care, PEPPER-study and in the potential PSMA PET/CT strategy. A: Standard of care. B: PEPPER-study. C: PSMA PET/CT strategy (skeletal scintigraphy was replaced by [⁶⁸Ga]Ga-PSMA-11 PET/CT and no ePLND in case of positive iN1 and iM1 findings on [⁶⁸Ga]Ga-PSMA-11 PET but only ePLND in case of negative PSMA). ePLND Extended pelvic lymph node dissection, MRI magnetic resonance imaging, MSKCC Memorial Sloan Kettering Cancer Center, PET/CT positron emission tomography/computed tomography, PSMA prostate specific membrane antigen