Rapid developments in imaging and treatment with radiopharmaceuticals targeting prostate cancer pose issues for the development of guidelines for their appropriate use. To tackle this problem, international experts representing medical oncologists, urologists, radiation oncologists, radiologists, and nuclear medicine specialists convened at the European Association of Nuclear Medicine Focus 1 meeting to deliver a balanced perspective on available data and clinical experience of imaging in prostate cancer, which had been supported by a systematic review of the literature and a modified Delphi process.
Relevant conclusions included the following: diphosphonate bone scanning and contrast-enhanced CT are mentioned but rarely recommended for most patients in clinical guidelines; MRI (whole-body or multiparametric) and prostate cancer-targeted PET are frequently suggested, but the specific contexts in which these methods affect practice are not established; sodium fluoride-18 for PET-CT bone scanning is not widely advocated, whereas gallium-68 or fluorine-18 prostate-specific membrane antigen gain acceptance; and, palliative treatment with bone targeting radiopharmaceuticals (rhenium-186, samarium-153, or strontium-89) have largely been replaced by radium-223 on the basis of the survival benefit that was reported in prospective trials, and by other systemic therapies with proven survival benefits. Although the advances in MRI and PET-CT have improved the accuracy of imaging, the effects of these new methods on clinical outcomes remains to be established. Improved communication between imagers and clinicians and more multidisciplinary input in clinical trial design are essential to encourage imaging insights into clinical decision making.
The Lancet. Oncology. 2018 Dec [Epub]
Stefano Fanti, Silvia Minozzi, Gerald Antoch, Ian Banks, Alberto Briganti, Ignasi Carrio, Arturo Chiti, Noel Clarke, Matthias Eiber, Johann De Bono, Karim Fizazi, Silke Gillessen, Sam Gledhill, Uwe Haberkorn, Ken Herrmann, Rodney J Hicks, Frederic Lecouvet, Rodolfo Montironi, Piet Ost, Joe M O'Sullivan, Anwar R Padhani, Jack A Schalken, Howard I Scher, Bertrand Tombal, R Jeroen A van Moorselaar, Heindrik Van Poppel, Hebert Alberto Vargas, Jochen Walz, Wolfgang A Weber, Hans-Jürgen Wester, Wim J G Oyen
Nuclear Medicine Division, Policlinico S Orsola, University of Bologna, Bologna, Italy. Electronic address: ., Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, Dusseldorf, Germany., European Cancer Organisation and European Men's Health Forum, Ulster, UK., Division of Oncology and Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy., Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Humanitas University and Humanitas Research Hospital, Milan, Italy., The Christie Hospital, Manchester, UK., Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany., The Institute of Cancer Research, London, UK., Department of Cancer Medicine, Institut Gustave Roussy, Paris, France., Division of Cancer Sciences, University of Manchester and The Christie Hospital, Manchester, UK; Division of Oncology and Division of Haematology, Kantonsspital St Gallen and University of Bern, Bern, Switzerland., Movember Foundation, Melbourne, VIC, Australia., Department of Nuclear Medicine and German Cancer Research Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany., Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany., Cancer Imaging, Peter MacCallum Cancer Institute, Melbourne, VIC, Australia., Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium., Genitourinary Cancer Program, Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy., Genitourinary Program, Ghent University Hospital, Ghent, Belgium., Department of Radiotherapy and Experimental Cancer Research, Queen's University, Belfast, UK., Mount Vernon Cancer Centre, Mount Vernon Hospital, London, UK., Department of Experimental Urology, Radboud University Medical Centre, Nijmegen, Netherlands., Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA., Department of Urology, Vrije Universiteit University Medical Center, Amsterdam, Netherlands., Urology, University Hospital Katholieke Universiteit Leuven, Leuven, Belgium., Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France., Lehrstuhl für Pharmazeutische Radiochemie, Technische Universität München, Garching, Germany., Department of Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands; Department of Nuclear Medicine, The Institute of Cancer Research and The Royal Marsden National Health Service Foundation Trust, London, UK.