A Clinician’s Guide to Next Generation Imaging in Patients with Advanced Prostate Cancer (Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence [RADAR] III)

The advanced prostate cancer therapeutic landscape has changed dramatically over the last several years, resulting in improved overall survival for patients with both castration-naive and castration-resistant disease. The evolution and development of novel next-generation imaging (NGI) techniques will affect diagnostic and therapeutic decision-making. Clinicians must navigate when and which NGI techniques to use and how to adjust treatment strategies based upon their results, oftentimes in the absence of correlative therapeutic data. Therefore, guidance is needed based on the best available information and current clinical experience.
The RADAR III Group convened to offer guidance on the use of NGI to stage prostate cancer based on available data and clinical experience. The group also discussed the potential impact of NGIs on treatment options based on earlier detection of disease.

The group unanimously agreed that progression to metastatic disease is a seminal event for patient management. NGI techniques are able to detect previously undetectable metastases, which could redefine the phases of prostate cancer progression. Hence, earlier treatment, either systemic or locally directed, may positively alter patient outcomes.

The RADAR III Group recommends NGI techniques for select patients suspected of disease progression based on laboratory (biomarker) values, comorbidities, and symptoms. Currently, 18F-fluciclovine and 68Gallium (Ga) PSMA PET/CT are the NGI agents with a favorable combination of availability, specificity, and sensitivity. There is ongoing research for additional NGI technologies, which may offer improved diagnostic accuracy and therapeutic options. As NGI techniques evolve and presumably result in improved global accessibility, a clinician’s ability to detect micrometastases may be enhanced for both decision-making and patient outcomes.

Authors: E. David Crawford, Phillip J. Koo, Neal Shore, Susan F. Slovin, Raoul S. Concepcion, Stephen J. Freedland, Leonard G. Gomella, Lawrence Karsh, Thomas E. Keane, Paul Maroni, David Penson, Daniel P. Petrylak, Ashley Ross, Vlad Mouraviev, Robert E. Reiter, Chaitanya Divgi, Evan Y. Yu Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence (RADAR III) Group

Crawford, E. David et al. A Clinician’s Guide to Next Generation Imaging in Patients With Advanced Prostate Cancer (Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence [RADAR] III). The Journal of Urology

Further Related Content:
Watch: Imaging Modality and Recommendations Included in RADAR 3: Interview with Phillip Koo
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