Dual PSMA and FDG PET Imaging for Patients With Advanced Prostate Cancer

Inclusion Criteria: * Male, age ≥ 18 years * Histologically or cytologically confirmed prostate cancer (adenocarcinoma) * Poor risk patients with mCSPC at study enrollment * De novo or recurrent high volume mCSPC as per conventional imaging (CT chest abdomen pelvis, or MRI, plus bone scan) prior to starting ADT and ARPI * High or low volume mCSPC plus PSA ≥4.0 after 6-8 months of initiating ADT * Willing to undergo study PET scans and remain under the care of medical oncology, radiation oncology or urology physician at Princess Margaret Cancer Center. * No prior PSMA or FDG PET imaging within the last 60 days at each specified time point on study * Patients enrolled in clinical trials are eligible if they satisfy all other criteria of eligibility Exclusion Criteria: * Under a randomized-controlled trial with unknown allocation of systemic therapy * Inability to undergo or successfully complete PSMA PET and FDG PET imaging exams * Unable to provide written consent by patient and their legal representatives * In the opinion of the treating physician: * conditions which would significantly impair the patient's ability to comply with study procedures and follow up * Significant uncontrolled comorbidity, which may negatively impact the safety or interpretability of study PET imaging * another active malignancy * patient on dialysis * another radioisotope or investigational systemic agent within 5 half-lives prior to PET imaging