Pancreatic NETs are uncommon malignancies with significant clinical heterogeneity. WHO grade can predict biological behaviour, but this is often hard to measure accurately prior to resection. Dual PET imaging with 68Ga-DOTATATE/18F-FDG PET holds the promise of a “virtual biopsy”, predicting biological course both before resection and in the setting of advanced disease. At the same time, there are a number of emerging therapies for pNET with randomized clinical trials being published in the last few years. This presentation will cover the use of PET imaging to predict biology in pNET and discuss recent trial evidence for systemic therapy in pNETs (including PRRT trials).