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Table 2 Unexpected PSMA PET-CT findings contemporaneously documented to alter the referring urologist’s preference regarding surgical management

From: High negative predictive value of 68Ga PSMA PET-CT for local lymph node metastases in high risk primary prostate cancer with histopathological correlation

Case No.Pre-PET TNM StageUrologist’s Pre-PET Preference To Offer SurgeryPost-PET TNM StageUnexpected PET FindingTreatment Performed
1M1a (para-aortic lymph nodes)DeclineN0 M0No lymph node PSMA uptakeRP-PLND
2N0 M0OfferN1M1aNon-regional lymph node metastases (extending above diaphragm)Systemic therapy
3T3M1b (lumbar spine and iliac bone)DeclineN0 M0No bony PSMA uptakeRP-PLND
4T3 N0 M0OfferN1 M0Presacral and internal iliac lymph node metastasesWhole pelvis radiotherapy and hormone therapy
5T3aN0 M0OfferN0 M1Solitary vertebral metastasisWhole pelvis radiotherapy, hormone therapy, stereotactic radiotherapy to metastatic deposit
6T3aN0 M0OfferN1 M0Presacral and internal iliac lymph node metastasesWhole pelvis radiotherapy and hormone therapy
7T2cN0 M0OfferN1M1bNon-regional lymph node and bony metastasesSystemic therapy
8T1 N0 M0OfferN1, possible M1bLocal lymph node metastases and possible iliac bone PSMA uptakeWhole pelvis radiotherapy and hormone therapy
9T3 N1 M0OfferN1M1bNon-regional lymph nodes and multiple bony metastasesHormone therapy
10T2cN0 M0OfferN1M1bNon-regional lymph nodes and bony metastasesHormone therapy
11T3 N0 M0OfferN1M1aNon-regional lymph node metastasesHormone therapy
  1. RP-RPLND Radical prostatectomy with pelvic lymph node dissection