Alicia Morgans: Hi. I'm so excited to be at SOGUG 2022 in Madrid where I have the opportunity to speak with Dr. Mercedes Mitjavila, who is speaking with us about imaging and its use in advanced prostate cancer. Thank you so much for being here today.

Mercedes Mitjavila: Thank you very much.

Alicia Morgans: Wonderful. You gave a wonderful talk here at SOGUG, and I wonder, can you comment a little bit on the conversations that you've had about thinking about imaging in prostate cancer? When is it useful? How can we incorporate it and use nuclear medicine in our prostate cancer practices?

Mercedes Mitjavila: Now, we have a big opportunity because there are development of PSMA imaging with PET technology, so we have a great sensibility and high specificity in order to localize the disease, and when you use PET PSMA, you can find the disease where you don't know, so you change the stratification of the patients and you can change probably the treatment, now we have to know if we have changed, too, the overall survival or the progression for survival. We have the opportunity to have a big role in the management of the patients with cancer.

Alicia Morgans: It's so important, as you say, for the nuclear medicine doctors to now play such an integral role in the care, and I think it's exciting that we are able now to change our treatments based on the disease that you are showing us is there when we couldn't see it before. Which disease states do you find PSMA imaging to be most useful in?

Mercedes Mitjavila: Nowadays, I think in the relapse, biochemical relapse, because usually in this scenario the conventional imaging is narrative, so you don't know what happened with the patients, and when you use PET imaging, you can follow the disease and you can change the treatment or give the local treatment to the patient.

Alicia Morgans: It's so important, I think, when we think about biochemical recurrence in particular. Is there a cutoff of PSA that you think about below which you would not recommend PSMA PET imaging?

Mercedes Mitjavila: The paper says that, up to 0.2, you can find the disease, but I think we have to wait little more, 0.4 or 0.5 in order that to obtain positive images.

Alicia Morgans: The sensitivity is just so low at 0.2.

Mercedes Mitjavila: It's not low, 40%, 50%, but you lost a big quantity of patients, and I think if you don't use the technique in the right moment, you say, "Ah, it's not useful." See, I think if we can wait a little more in order for the PSMA was higher and the results of the images was positive.

Alicia Morgans: How long have you been able to use PSMA PET imaging in Madrid in your practice?

Mercedes Mitjavila: Now, we have there is another register, so we have to use as compassionate use, so you can use in the routine, but we are for more or less, one year we can use the PSMA.

Alicia Morgans: It has transformed things, certainly in my practice, not just in biochemical recurrence, but in high risk localized patients as well. Are you using PSMA PET in the localized setting yet?

Mercedes Mitjavila: We can't.

Alicia Morgans: Not yet.

Mercedes Mitjavila: Because we have to ask to the agency and they only accept the studies with biochemical relapse.

Alicia Morgans: Well, someday.

Mercedes Mitjavila: Yes, I think probably the next year.

Alicia Morgans: Wonderful, so where do you anticipate us going? What do we still need to learn with PSMA PET in order to make it maximally useful?

Mercedes Mitjavila: I think the important is not only to obtain the images, the important is to change the outcome of the patients. For that, we need time because now, we are looking where I find more lesions, sometimes we change the treatment, but we don't know if really, we change the outcome of the patients in order of progression for survival or overall survival. It's very difficult sometimes to change the treatment only because the PET imaging is positive and you don't know if really what happened if you change the treatment, so we need to learn a lot. It's necessary to perform all the techniques the same way to standardize the reports, in order to all the physicians speak the same language, that the clinicians understand our reports, and then follow the patients in order if we change the treatment, we change the outcome. There are no sense to change the treatment with no change to the outcome. It spends more money. No. We need really to change the outcome of the patients, so we need trials in order to know that.

Alicia Morgans: I completely agree and I'm so excited that you took the time to talk at SOGUG, and then also, the time to talk with me today. I could not agree more. We need to speak the same language and we need to follow our patients and understand if the changes we make actually impact their outcomes. I think you and I, hopefully, can continue to work and find those answers. Thank you so much for your time today.

Mercedes Mitjavila: Thank you for you.