Page 9 - The Contemporary Role of Conventional Imaging for Staging, Re-staging, and Monitoring Prostate Cancer: Impact on Management

Table 4. Summary of Recommendations: Monitoring During Systemic Treatment

Indication Modality

APCCC 2017 mCNPC: staging and monitoring • CT
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51% of panel voted for: • Bone scan
• Image at baseline
• Image at PSA nadir/completion of 6 cycles of
docetaxel as part of chemo-hormonal therapy
• Image at progression (confirmed PSA rise
and/or clinical progression)
18% of panel voted for:
• Image at baseline
• Image every 3-6 mo regularly
mCRPC: monitoring on first-line therapy • CT chest and abdomen
54% of panel of voted for: • Bone scan
• Image at baseline
• Image every 3-6 mo
28% of panel voted for:
• Image at baseline
• Image at PSA nadir and at progression
(confirmed PSA rise and/or clinical progression)

Aggressive variant mCRPC*: monitoring • CT
• Standard imaging (62% of panel vote) • Bone scan
• Next generation imaging (36% of panel vote)
EAU-ESTRO-SIOG 2016 26 During hormonal treatment in mHSPC • Bone scan
• Image if new onset bone pain or PSA • Additional imaging modalities guided by
progression suggesting mCRPC status, if a symptoms and possible subsequent
treatment modification is considered treatments

mCRPC • Bone scan
• Image at baseline • Chest, abdopelvic CT
• Image at least every 6 mo
NCCN 2018 13 During systemic therapy for CNPC • Bone imaging for symptoms and as often as
every 6-12 mo
During systemic therapy for M0 CRPC • Bone scans and CT or MRI regularly to
• Treatment options (observation, apalutamide, assess clinical benefit
other secondary hormone therapy) • If PSA increasing, work-up for progression :
†
Chest x-ray or chest CT
n
Bone imaging
n
Abdopelvic CT or MRI with/without contrast
n
During initial systemic therapy for M1 CRPC • Bone scans and CT or MRI regularly to assess
clinical benefit
During subsequent systemic therapy for • Work-up for progression :
†
M1 CRPC Chest x-ray or chest CT
n
Bone imaging
n
Abdopelvic CT or MRI with/without contrast
n
*Aggressive variant mCRPC includes neuroendocrine differentiation and/or low or absent androgen receptor expression, exclusive visceral metastases; rapid progression
with correlation with PSA kinetics (no consensus on definition).
† Consider C-11 choline PET/CT or PET/MRI or F-18 fluciclovine PET/CT or PET/MRI for further soft tissue evaluation or F-18 NaF PET/CT for further bone evaluation.
APCCC = Advanced Prostate Cancer Consensus Conference; EAU = European Association of Urology; ESTRO = European Society for Radiotherapy and Oncology;
NCCN = National Comprehensive Cancer Network; SIOG = International Society of Geriatric Oncology.

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