2020 Recommendations on Use of PSMA PET or Next-Generation Imaging (NGI; i.e., PET/CT, PET/MRI and Whole-Body MRI)*
| Clinical stage | EAU-EANM-ESTRO-ESUR-SIOG (17,35) | Strength rating | ASCO (39) | Strength rating |
| Diagnosis | Not recommended | Not recommended | ||
| Staging | PSMA PET; not recommended; perform at least cross-sectional imaging for intermediate- and high-risk patients | When conventional imaging is negative in patients with high risk of metastatic disease, NGI may add clinical benefit, although prospective data are limited; when conventional imaging is suggestive or equivocal, NGI may be offered to patients for clarification of equivocal findings or detection of additional sites of disease, which could potentially alter management, although prospective data are limited | Weak | |
| BCR | Perform PSMA PET/CT if PSA > 0.2 ng/mL and if results will influence subsequent treatment decisions | Weak | Goal of therapy and potential use of salvage local therapies in these scenarios should guide choice of imaging | Moderate |
| PSA persistence | Offer PSMA PET to men with persistent PSA > 0.2 ng/mL to exclude metastatic disease | Weak | For men for whom salvage local or regional therapy is contemplated, there is evidence supporting NGI for detection of local or distant sites of disease | Moderate |
| Before salvage radiation therapy | Perform PSMA PET/CT (if available) or 18F-fluciclovine or choline in patients fit for curative salvage treatment | Strong | For men for whom SRT is contemplated, PSMA imaging should be offered (or NGI) as it has superior disease detection performance characteristics and may alter patient management | High |
| Nonmetastatic CRPC | With more sensitive imaging techniques such as PSMA PET/CT or whole-body MRI, more patients are expected to be diagnosed with early metastatic CRPC | Not reported | For men with nonmetastatic CRPC, NGI can be offered only if change in clinical care is contemplated | Moderate |
| Metastatic CRPC | Use of choline or PSMA PET/CT scans for progressing CRPC is unclear and most likely not as beneficial as for patients with BCR or hormone-naïve disease | Not reported | Use of NGI in this cohort is unclear, with paucity of prospective data; when change in clinical care is contemplated and there is high clinical suspicion of subclinical metastasis despite negative conventional imaging, use of NGI could be contemplated in ▪▪▪; if there is clear evidence of radiographic progression on conventional imaging, NGI should not be routinely offered; NGI may play role if performed at baseline to facilitate comparison of imaging findings/extent of progression of disease | Insufficient |
↵* According to the guidelines of the European Association of Urology (EAU), European Association of Nuclear Medicine (EANM), European Society for Radiotherapy and Oncology (ESTRO), European Society of Urogenital Radiology (ESUR), and International Society of Geriatric Oncology (SIOG) (56) and the guidelines of the American Society of Clinical Oncology (ASCO) (52).