Page 10 - The Contemporary Role of Conventional Imaging for Staging, Re-staging, and Monitoring Prostate Cancer: Impact on Management

Nowadays, the challenge is to diagnose metastasis
The Future: Beyond the and detect true cancer progression under systemic

Conventional Imaging therapy as early as possible in order to improve
management. Research in molecular imaging of
metastatic prostate cancer has undergone a shift from
maging is a critical tool for decision-making over
Ithe prostate cancer disease continuum. Use of traditional diagnostic imaging accuracy analyses,
conventional modalities should be judicious with focusing on detection rates and sensitivity, toward
consideration of their accuracy and the implications molecular imaging as a quantitative prognostic
of false positive or false negative results for patient biomarker that informs risk stratification in terms of
management. survival, particularly in mCRPC patients. Another trend
in imaging research is evaluating the impact of imaging
Novel MRI techniques and PET tracers continue to be on prostate cancer management, a better indicator of
studied for the detection of lymph node metastases the true clinical value of a test, rather than sensitivity or
during primary staging. 18F-fluciclovine, 18F-choline, specificity alone. 7
and PSMA-binder PET/CT offer greater accuracy
than conventional imaging with their ability to detect As imaging evolves, there will likely be greater demand
recurrence earlier and to improve lesion targeting for evidence of the impact of the imaging modality on
with salvage therapy. Newer imaging modalities morbidity and mortality. The availability of tracers,
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may be particularly valuable in clinical scenarios experienced readers, and nuclear medicine services
when decisions are influenced by tumour burden and will also influence the adoption of new methods. As
greater sensitivity is required. As such, next-generation new therapeutic strategies are integrated into clinical
technologies have enabled the identification of practice, comprehensive imaging guidelines will be
metastatic foci at lower PSA levels. Indeed, molecular required to optimize the selection of therapy and
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imaging can detect cancer cells rather than their effect management of patients with prostate cancer.
on bone or the anatomy, which will enable direct
monitoring of the cancer itself and may be integrated
in new approaches such as systemic treatment
layering.

PSA measurement

Imaging

Recurrent disease
before ADT
Symptoms
Primary
locoregional
therapies

PSA level

Non/Pre-metastastic Metastatic

Hormono-Sensitive Castration-resistant
Time

Figure 2. Conceptualizing the value of clinical tools, including conventional imaging,
for monitoring disease progression across the prostate cancer continuum.

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