Page 7 - The Contemporary Role of Conventional Imaging for Staging, Re-staging, and Monitoring Prostate Cancer: Impact on Management
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The Use of Imaging Modalities Detecting Disease Progression
for Monitoring During he timing and frequency of imaging during systemic
Ttherapy are guided by clinical trial protocols and
Systemic Treatment trial outcomes. Recent data have provided some insight
into the relationship between PSA increases and
or men receiving systemic therapy for advanced disease progression in men with CRPC.
Fprostate cancer, monitoring for disease progression
with or without concomitant PSA rise enables early In the setting of high-risk, non-metastatic CRPC,
identification of treatment failure, and possibly the SPARTAN trial showed that the time between
reduces complications and treatment-related toxicity. PSA progression (average baseline PSADT was ≤5
Improved vigilance may also hasten the introduction months) and development of metastases was 16.2
of a potentially life-prolonging subsequent therapy, months in patients receiving placebo. Similarly, the
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which will delay the onset of symptomatic disease, and PROSPER trial included men with M0 CRPC, PSADT
optimize the use of bone-targeted agents to reduce ≤10 months and PSA ≥2 ng/mL, and the median time
morbidity. to metastases was 14.7 months in the placebo arm. In
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these trials, detection of metastases was determined by
Until recently, the use of systemic therapies such as conventional imaging. 22,23
chemotherapy and androgen receptor axis-targeted
agents was focused in the setting of metastatic CRPC. In the PREVAIL trial, men with asymptomatic or mildly
There is now evidence to support the adoption of these symptomatic, chemotherapy-naïve mCRPC were
treatments in earlier stages of the disease. treated with enzalutamide. A post hoc analysis showed
that 24.5% of men had radiographic progression
Guidelines and recommendations are provided without PSA progression (PSA progression defined as
according to the clinical state: >1.05 times PSA level from 3 months earlier). This
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study clearly demonstrates the importance of follow-
• Metastatic hormone- (or castration-) naïve
prostate cancer (mHNPC/mCNPC) – untreated up imaging in CRPC patients undergoing treatment
disease with an androgen receptor axis inhibitor.
• Metastatic hormone-sensitive prostate cancer
(mHSPC) – ADT-sensitive disease
• Non-metastatic castration-resistant prostate
cancer (M0 CRPC)
• Metastatic castration-resistant prostate cancer
(mCRPC or M1 CRPC)
Hormone/Castration-Naive Hormone-Senstive Castration-Resistant
Prostate Cancer Prostate Cancer Prostate Cancer
Figure 1. Variations in Terminology to Describe Prostate Cancer States Along Disease Continuum
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