Next Generation Imaging for High-Risk Locally Advanced Prostate Cancer - When Should you Use It?

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07/07/23

My 2023 Update on using PSMA-PET/CT for Locally Advanced Prostate Cancer. When should you use it?

Learning Objectives:

To show that bone and CT scans are at the centre of patient care of men with very-high risk/ locally advanced prostate cancer
Highlight the proven prognostic and predictive roles of BS/CT scans for directing patient care
To frame next-generation imaging as problem solvers after BS/CT scan assessments; because immediate use confuses management
To acknowledge that higher-quality evidence on management &/or outcomes is needed if there is to be substitution of BS/CT by NGI

Take Home Points:

High sensitivity and specificity imaging has the potential to change the disease course/improve outcomes for men with high-risk localized and locally advanced prostate cancer
Use WB-MRI to clarify uncertain (solitary or low-volume) bone scan lesions
Net benefits of PSMA-PET/CT in HR/LAPC remain unknown
Biases can arise from higher sensitivity imaging including stage/grade migrations, lead time, and length time bias
Escalation & de-escalation therapy changes are brought about
The availability of treatments for µM may NOT result in a meaningful altered clinical risk: benefit ratio; prospective studies are needed

Good Reference: Bukavina L, et al. Incorporating PSMA-PET/CT in Management Decisions for Men with Newly Diagnosed or Biochemically Recurrent Prostate Cancer. Eur Urol. 2023 Jun;83(6):521-533.