Dear colleagues,

As part of outpatient specialist care (ASV), it is possible to request a PSMA-PET for our patients with prostate cancer. However, the inclusion criteria are comparatively limited and restricted to patients who have been shown to benefit from the examination. In order to spare the patient the disappointment of a PSMA PET that has already been promised, we list the criteria mentioned here once again:

ASV URO A1: After prostatectomy, absence of PSA drop (less than 0.2 ng/ml) after 3 months with 2 measurements.

- PSMA-PET is useful to prevent subsequent salvage radiotherapy from not addressing the actual tumor location (e.g. "out of field" radiotherapy).

ASV URO A2: After prostatectomy alone (PSA elevated in 2 measurements above 0.2 ng/ml) or after radiotherapy alone (PSA in 2 measurements above nadir + 2). If PSA ≥ 10 ng/ml, conventional imaging must be performed first. In the case of metastases on conventional imaging, PSMA-PET is not possible as part of ASV.

- PSMA-PET is useful here to prevent salvage therapy from not addressing the actual tumor location ("for example, salvage prostatectomy despite distant metastases").

ASV URO A3: High-risk PCA before curative intended therapy (e.g. EBRT or RPE).

- PSMA-PET is useful as it minimizes the risk of treating a patient with distant metastases locally.

ASV URO B1: Before planning radioligand therapy.

- PSMA-PET is useful because adequate tracer uptake must be ensured in advance.

In the unfortunately more frequent cases of already known metastasis or in patients who have already undergone radical prostatectomy AND radiotherapy, PSMA-PET is not possible as part of ASV, as there is no certainty that PSMA-PET will be beneficial for these patients in the long term. PSMA-PET may be clinically useful for these patients in individual cases, but it is not reimbursed under ASV.

Yours sincerely,
Christoph-A. J. v. Klot
Ltd. senior physician