BERKELEY, CA (UroToday.com) - The Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence (RADAR) working group, chaired by Drs. E. David Crawford and Daniel Petrylak, first convened in early 2013.
The multidisciplinary group was comprised of experts in urology, medical oncology, radiation oncology, and radiology -- from both the community and from academic settings.
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Optimizing the imaging of advanced disease will have a significant impact on the appropriateness and sequencing of the many newly-approved therapies in the CRPC arena. The main charge for the group was to review and provide guidance with regards to early detection of metastatic disease, particularly in the M0 CRPC group of patients; however recommendations were also generated for imaging evaluation at diagnosis and biochemical recurrence. There is a clear lack of consensus among various organizations regarding eligibility criteria, type of imaging modality, and frequency of scanning, with none directly addressing the M0 CRPC space. Members of the group shared stories of the guidelines leading to denials of imaging exams by insurance companies despite the fact that many of the guidelines focus mainly on primary prostate cancer staging. These unreasonable obstacles place excessive stresses on a physician’s practice and negatively impact patient care. Our goal was to provide a comprehensive and user-friendly set of recommendations that would empower the physicians taking care of prostate cancer patients with practical options to detect early metastatic disease. We hope these recommendations can be seamlessly integrated into one’s own practice and also incorporated into decision-support software systems which are increasingly employed in radiology departments and hospitals.
With regards to eligibility criteria and frequency of scanning, there is a clear lack of published data. As a result, recommendations were produced based on available literature and consensus clinical experience. Scanning before change-of-therapy to establish a new baseline was also added, which is an indication often not formally included in other guidelines.
Advanced imaging techniques using PET/CT were discussed at length. Though more controlled studies are needed, there is an important role for NaF PET/CT for evaluating bone health. We left the specific use of NaF at the physician’s discretion, but with data currently being collected through the National Oncologic PET Registry (NOPR), we expect more information to be available in the near future which should help clarify the appropriate use of this technology. Other PET radio-pharmaceuticals such as C11 or F18 choline were not included in our recommendations due to the lack of sufficient clinical data, high cost, and lack of availability. We do acknowledge that these agents are very promising and will no doubt change the landscape for the detection of disease as well as for monitoring response to therapy. We look forward to revising these recommendations based on results from ongoing and forthcoming clinical trials.
RADAR II recently met again to continue the discussion with regards to early detection of disease by discussing the clinical benefits of early diagnosis and treatment. The literature in this space was reviewed and we look forward to sharing this information, as well as proposing a collective vision for future advancement.
Phillip J. Koo, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Chief, Nuclear Medicine and Molecular Imaging
Program Director, Nuclear Radiology Fellowship
Assistant Professor of Radiology
University of Colorado School of Medicine
Aurora, CO 80045 USA