Controversies in the use of next-generation imaging for evaluation and treatment decision-making in patients with prostate cancer after biochemical recurrence: views from a Spanish expert panel.

Introduction: Diagnosing and managing biochemical recurrence (BCR) of prostate cancer (PCa) following primary radical treatment remain a challenge. Implementing next-generation imaging (NGI) techniques has improved metastases detection. However, access to these techniques is heterogeneous, and controversies surround their use and subsequent treatment decisions. In November 2023, a multidisciplinary expert meeting was organized to discuss these aspects. This information was further reviewed in November 2024.

Areas covered: NGI-specific tracers' selection, evidence supporting patient selection for NGI after BRC, current treatment strategies in patients with BRC, and the role of NGIs in current and future therapeutic approaches.

Expert opinion: Despite improved detection performance compared to conventional imaging techniques, the application of NGIs to treatment decision-making and the impact on patient outcomes are yet to be proven. Given the lack of guidance, opinions and recommendations from multidisciplinary expert panels are valuable for diagnosing and adequately treating patients with BRC after radical treatment.