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A Clinician's Guide to Next Generation Imaging in Patients With Advanced Prostate Cancer (RADAR III)
E David Crawford1, Phillip J Koo2, Neal Shore3
1University of Colorado , Aurora , Colorado.
Purpose:
The advanced prostate cancer therapeutic landscape has changed dramatically in the last several years, resulting in improved overall survival of patients with castration naïve and castration resistant disease. The evolution and development of novel next generation imaging techniques will affect diagnostic and therapeutic decision making. Clinicians must navigate when and which next generation imaging techniques to use and how to adjust treatment strategies based on the results, often in the absence of correlative therapeutic data. Therefore, guidance is needed based on best available information and current clinical experience.
Materials And Methods:
The RADAR (Radiographic Assessments for Detection of Advanced Recurrence) III Group convened to offer guidance on the use of next generation imaging to stage prostate cancer based on available data and clinical experience. The group also discussed the potential impact of next generation imaging on treatment options based on earlier detection of disease.
Results:
The group unanimously agreed that progression to metastatic disease is a seminal event for patient treatment. Next generation imaging techniques are able to detect previously undetectable metastases, which could redefine the phases of prostate cancer progression. Thus, earlier systemic or locally directed treatment may positively alter patient outcomes.
Conclusions:
The RADAR III Group recommends next generation imaging techniques in select patients in whom disease progression is suspected based on laboratory (biomarker) values, comorbidities and symptoms. Currently 18F-fluciclovine and 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography are the next generation imaging agents with a favorable combination of availability, specificity and sensitivity. There is ongoing research of additional next generation imaging technologies, which may offer improved diagnostic accuracy and therapeutic options. As next generation imaging techniques evolve and presumably result in improved global accessibility, clinician ability to detect micrometastases may be enhanced for decision making and patient outcomes.
Insights
Next-generation imaging helps detect advanced prostate cancer recurrence earlier, guiding treatment decisions. These advanced techniques improve patient outcomes by identifying previously undetectable metastases.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- The treatment landscape for advanced prostate cancer has significantly improved survival for patients with both castration-naive and castration-resistant disease.
- Novel next-generation imaging techniques are emerging, impacting diagnostic and therapeutic strategies.
- Clinicians require guidance on integrating these advanced imaging modalities into treatment planning, especially with limited correlative therapeutic data.
Purpose of the Study:
- To provide guidance on the use of next-generation imaging for staging prostate cancer.
- To assess the impact of next-generation imaging on treatment options through earlier disease detection.
Main Methods:
- The RADAR (Radiographic Assessments for Detection of Advanced Recurrence) III Group convened to develop recommendations.
- The group reviewed available data and clinical experience regarding next-generation imaging in prostate cancer.
- Discussions focused on the implications of earlier disease detection on treatment strategies.
Main Results:
- Progression to metastatic disease is a critical event in advanced prostate cancer management.
- Next-generation imaging can detect previously undetectable metastases, potentially redefining prostate cancer staging.
- Earlier detection of metastases may enable more timely and effective systemic or local treatments, improving patient outcomes.
Conclusions:
- Next-generation imaging is recommended for select patients with suspected disease progression based on biomarkers, comorbidities, or symptoms.
- 18F-fluciclovine and 68Ga-PSMA PET/CT are currently favored agents due to their availability, specificity, and sensitivity.
- Ongoing research into new imaging technologies promises enhanced diagnostic accuracy and therapeutic options, improving the detection of micrometastases and patient outcomes.