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J Urol. 2019 Apr;201(4):682-692. doi: 10.1016/j.juro.2018.05.164.

A Clinician's Guide to Next Generation Imaging in Patients With Advanced Prostate Cancer (RADAR III).

Author information

1
University of Colorado , Aurora , Colorado.
2
Banner MD Anderson Cancer Center , Phoenix , Arizona.
3
Carolina Urologic Research Center , Charleston , South Carolina.
4
Memorial Sloan Kettering Cancer Center , New York , New York.
5
The Comprehensive Prostate Center , Nashville , Tennessee.
6
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center , Los Angeles , California.
7
Kimmel Cancer Center, Thomas Jefferson University , Philadelphia , Pennsylvania.
8
The Urology Center of Colorado , Aurora , Colorado.
9
Myrtle Beach, Medical University of South Carolina , Charleston , South Carolina.
10
Denver and University of Colorado , Aurora , Colorado.
11
Vanderbilt University , Nashville , Tennessee.
12
Yale University , New Haven , Connecticut.
13
GenomeDx Biosciences , Flower Mound , Texas.
14
Nova Southeastern University , Fort Lauderdale , Florida.
15
University of California-Los Angeles , Los Angeles , California.
16
Columbia University College of Physicians and Surgeons , New York , New York.
17
University of Washington , Seattle , Washington.

Abstract

PURPOSE:

The advanced prostate cancer therapeutic landscape has changed dramatically in the last several years, resulting in improved overall survival of patients with castration naïve and castration resistant disease. The evolution and development of novel next generation imaging techniques will affect diagnostic and therapeutic decision making. Clinicians must navigate when and which next generation imaging techniques to use and how to adjust treatment strategies based on the results, often in the absence of correlative therapeutic data. Therefore, guidance is needed based on best available information and current clinical experience.

MATERIALS AND METHODS:

The RADAR (Radiographic Assessments for Detection of Advanced Recurrence) III Group convened to offer guidance on the use of next generation imaging to stage prostate cancer based on available data and clinical experience. The group also discussed the potential impact of next generation imaging on treatment options based on earlier detection of disease.

RESULTS:

The group unanimously agreed that progression to metastatic disease is a seminal event for patient treatment. Next generation imaging techniques are able to detect previously undetectable metastases, which could redefine the phases of prostate cancer progression. Thus, earlier systemic or locally directed treatment may positively alter patient outcomes.

CONCLUSIONS:

The RADAR III Group recommends next generation imaging techniques in select patients in whom disease progression is suspected based on laboratory (biomarker) values, comorbidities and symptoms. Currently 18F-fluciclovine and 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography are the next generation imaging agents with a favorable combination of availability, specificity and sensitivity. There is ongoing research of additional next generation imaging technologies, which may offer improved diagnostic accuracy and therapeutic options. As next generation imaging techniques evolve and presumably result in improved global accessibility, clinician ability to detect micrometastases may be enhanced for decision making and patient outcomes.

KEYWORDS:

clinical decision-making; diagnostic imaging; neoplasm metastasis; practice guideline; prostatic neoplasms

PMID:
30077557
DOI:
10.1016/j.juro.2018.05.164
[Indexed for MEDLINE]

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