Despite subsequent data not confirming an increased bleeding risk compared to other therapies, the initial studies on pacritinib showed a signal for increased bleeding. Consequently, it is still advised that the drug be stopped for several days prior to any major surgical procedure as a safety precaution.

In cases of suspected glioma recurrence post-radiation, FET PET imaging can provide a more accurate diagnosis than MRI perfusion, even when MRI findings suggest tumor growth. This allows clinicians to avoid unnecessary changes in therapy based on potentially misleading MRI data.

There is a growing suspicion that conventional imaging understages many presumed early-stage lobular cancers. Using FES PET-CT upfront could detect small-volume metastatic disease missed by other methods. This would reclassify patients to a metastatic setting, sparing them the morbidity of major local surgeries that would not be curative.

While powerful, FES PET-CT is a specialized tool with key limitations. It is not effective for evaluating disease in the liver, a common site of breast cancer metastasis. Furthermore, it cannot detect any disease that has become estrogen receptor-negative. Therefore, it must be used as part of a broader imaging program, not as a standalone surveillance tool.

If lutetium-PSMA is approved and used upfront in hormone-sensitive disease, clinicians may become more comfortable with radioligands generally. This could lead them to use the enzalutamide-radium combination more frequently later on, paradoxically increasing radium's use by flipping the current treatment sequence.

The processing of bone biopsy samples can sometimes result in a false-negative finding for estrogen receptor (ER) status. If clinical suspicion remains high for ER-positive disease, an FES PET-CT can be used as a tiebreaker. A positive FES scan can confirm functional ER presence, overriding the biopsy and drastically altering patient care.

A biopsy can confirm ER-positive tissue, but FES PET-CT demonstrates that these receptors are functional and capable of binding. This distinction is critical, as some tumors may have non-functional receptors or heterogeneous expression. A positive FES scan provides strong evidence that a patient is a good candidate for endocrine therapy.

The introduction of highly sensitive PSMA PET scans means established endpoints like Metastasis-Free Survival (MFS) may no longer be valid. A metastasis detected by PET likely has a different, better prognosis than one found with older imaging, requiring new validation for this key endpoint.

The intensity and volume of FET PET activity serve as a powerful prognostic marker in glioma patients. Even when imaging suggests treatment-related changes rather than active tumor, elevated PET signals still correlate with a worse overall outcome, providing an additional layer of risk stratification.