Editing Management of Localized Prostate Cancer (section)

=== Metastatic Staging ===

====Indications ====

===== AUA =====
*'''[https://pubmed.ncbi.nlm.nih.gov/23659877/ 2023 AUA Guidelines on Early Detection of Prostate Cancer]'''
**'''<span style="color:#ff0000">Asymptomatic low/intermediate-risk: staging should NOT be performed</span>'''
***May be considered for unfavorable, intermediate-risk.
**'''<span style="color:#ff0000">High-risk: staging should be performed</span>'''
==== Modality[https://pubmed.ncbi.nlm.nih.gov/23659877/]====
*'''<span style="color:#ff0000">Cross sectional imaging (CT or multi-parametric MRI) and bone scan should be used to stage patients with clinically localized prostate cancer, when indicated.</span>'''
**For both mpMRI scan and CT scan, the assessment of nodal metastasis is based on size criteria, and these modalities have moderate sensitivity and high specificity.
**To evaluate for the presence of bone metastasis, conventional bone scan should be obtained as the initial staging study.
*'''<span style="color:#ff0000">Molecular imaging may be obtained to evaluate for metastases in patients with prostate cancer at high risk for metastatic disease with negative conventional imaging</span>'''
**Molecular imaging is also referred to as next generation imaging (NGI)
**'''Gallium 68 prostate-specific membrane antigen (PSMA)-11 (Ga 68 PSMA-11) and piflufolastat F-18 PSMA (18F-DCFPyL) PET scanning have been FDA approved for initial staging for patients at high risk of metastasis (as well as for evaluation of biochemical relapse after treatment).'''
***[https://pubmed.ncbi.nlm.nih.gov/32209449/ proPSMA] (2020) was a multicenter randomized trial that compared Ga-68 PSMA PET with conventional imaging using CT scan and bone scan in patients with high-risk prostate cancer before definitive therapy and found that Ga-68 PSMA PET scan was found to have a 27% greater accuracy than conventional imaging, with better sensitivity and specificity, in the detection of nodal or distant metastasis.
**Limited data to date demonstrating a clinical benefit to novel imaging modalities for patients with negative conventional imaging
***Identification of disease with molecular imaging may influence treatment (e.g., the addition of systemic therapy or metastases-directed therapy); uncertain  incremental oncologic benefit of altering treatment based on the identification of metastases with molecular imaging among patients with negative conventional imaging.