Although it's technically "off-thread" I'll provide perplexity AI's answer regarding imaging and the detection of biological reoccurrence, primarily to give an understanding of the power of this particular AI engine.

The most amazing thing about the particular question/answer that I list below is that it is the result of an "improved question" that perplexity recommended I ask, after it answered my relatively simple question that lacked specificity.

There were many more recommended "improved questions" which could also have been asked.... I list some of them at the bottom of my response.

The answers are always comprehensive and based on multiple sources this AI engine finds by performing "real time" internet searching.

I'm just scratching the surface of the power of this format and recommend you "put it to the test" yourself.

Q: How does next-generation imaging compare to conventional imaging in detecting prostate cancer recurrence?

A: Next-generation imaging (NGI) techniques have demonstrated significant advantages over conventional imaging methods in detecting prostate cancer recurrence. Here's a comparison of their performance:

Sensitivity and Detection Rates

Conventional Imaging
• CT scans and bone scans have low detection rates for recurrent disease, especially at low PSA levels:
o Less than 5% for bone scans
o Less than 15% for CT scans when PSA is under 10 ng/mL.

Next-Generation Imaging
• PET imaging, particularly with novel radiotracers, shows much higher sensitivity:
o PSMA PET-CT has detection rates of 46-50% at PSA levels as low as 0.2-0.49 ng/mL
o Choline PET has a detection rate of 62% for recurrent disease.
o 18F-fluciclovine (Axumin) PET can detect recurrence at PSA levels of 0.5-1 ng/mL.

Specificity and Accuracy
NGI techniques generally offer improved specificity compared to conventional methods:
• PSMA PET-CT has shown positive predictive values of 84-92% for detecting biochemical recurrence.
• 18F-DCFPyL and rhPSMA-7.3 tracers have demonstrated positive predictive values of 89% and 92%, respectively.

Early Detection of Micrometastases

NGI, especially PSMA PET-CT, has superior ability to detect micrometastases and small-volume disease that conventional imaging often misses.

This allows for earlier detection of recurrence at lower PSA levels.

Impact on Clinical Management
The improved detection capabilities of NGI have significant implications for patient care:
• NGI can alter treatment decisions in up to 70% of patients with biochemical recurrence.
• It enables more precise localization of recurrent disease, allowing for targeted treatments like salvage radiation therapy.

Guidelines and Recommendations
Medical societies are increasingly recommending NGI for evaluating biochemical recurrence:
• The National Comprehensive Cancer Network now prioritizes PSMA PET-CT as the imaging method of choice for biochemical recurrence.
• European and US medical societies have provided specific recommendations for using NGI in biochemical recurrence evaluation.

In conclusion, next-generation imaging techniques, particularly PET-CT with novel radiotracers like PSMA, offer significantly improved sensitivity, specificity, and detection rates compared to conventional imaging for prostate cancer recurrence.

This enhanced performance allows for earlier detection and more accurate localization of recurrent disease, potentially leading to better-informed treatment decisions and improved patient outcomes.

Recommended follow-up questions included:

What are the specific advantages of using PET/CT over conventional imaging for prostate cancer recurrence?

How do PSA levels affect the detection rates of next-generation imaging technologies?

What are the limitations of current next-generation imaging technologies in prostate cancer detection?

How has the recommendation for using NGI in biochemical recurrence evolved over time?

What impact does next-generation imaging have on treatment strategies for prostate cancer patients?