Rationale for modernising imaging in advanced prostate cancer Journal Article


Authors: Padhani, A. R.; Lecouvet, F. E.; Tunariu, N.; Koh, D. M.; De Keyzer, F.; Collins, D. J.; Sala, E.; Fanti, S.; Vargas, H. A.; Petralia, G.; Schlemmer, H. P.; Tombal, B.; de Bono, J.
Article Title: Rationale for modernising imaging in advanced prostate cancer
Abstract: Context To effectively manage patients with advanced prostate cancer (APC), it is essential to have accurate, reproducible, and validated methods for detecting and quantifying the burden of bone and soft tissue metastases and for assessing their response to therapy. Current standard of care imaging with bone and computed tomography (CT) scans have significant limitations for the assessment of bone metastases in particular. Objective We aimed to undertake a critical comparative review of imaging methods used for diagnosis and disease monitoring of metastatic APC from the perspective of their availability and ability to assess disease presence, extent, and response of bone and soft tissue disease. Evidence acquisition An expert panel of radiologists, nuclear medicine physicians, and medical physicists with the greatest experience of imaging in advanced prostate cancer prepared a review of the practicalities, performance, merits, and limitations of currently available imaging methods. Evidence synthesis Meta-analyses showed that positron emission tomography (PET)/CT with different radiotracers and whole-body magnetic resonance imaging (WB-MRI) are more accurate for bone lesion detection than CT and bone scans (BSs). At a patient level, the pooled sensitivities for bone disease by using choline (CH)–PET/CT, WB-MRI, and BS were 91% (95% confidence interval [CI], 83–96%), 97% (95% CI, 91–99%), and 79% (95% CI, 73–83%), respectively. The pooled specificities for bone metastases detection using CH-PET/CT, WB-MRI, and BS were 99% (95% CI, 93–100%), 95% (95% CI, 90–97%), and 82% (95% CI, 78–85%), respectively. The ability of PET/CT and WB-MRI to assess therapeutic benefits is promising but has not been comprehensively evaluated. There is variability in the cost, availability, and quality of PET/CT and WB-MRI. Conclusions Standardisation of acquisition, interpretation, and reporting of WB-MRI and PET/CT scans is required to assess the performance of these techniques in clinical trials of treatment approaches in APC. Patient summary PET/CT and whole-body MRI scans have the potential to improve detection and to assess response to treatment of all states of advanced prostate cancer. Consensus recommendations on quality standards, interpretation, and reporting are needed but will require validation in clinical trials of established and new treatment approaches. Modern imaging techniques. including whole-body magnetic resonance imaging and positron emission tomography/computed tomography scans with a variety of tracers, have the potential to address the unmet need for robust imaging that allows tumour detection and therapy evaluations in advanced prostate cancer. © 2016 European Association of Urology
Keywords: review; bone metastasis; diagnostic accuracy; sensitivity and specificity; clinical practice; diagnostic procedure; computer assisted tomography; image analysis; patient monitoring; prostate cancer; health care quality; health care cost; standardization; patient care; radiologist; diagnostic value; systematic review; choline; intermethod comparison; consensus development; nuclear medicine; tracer; fluorine 18; meta analysis; bone scintiscanning; medical expert; soft tissue metastasis; response assessment; diagnostic test accuracy study; health care availability; whole-body mri; whole body mri; advanced prostate cancer; human; male; diffusion mri; metastatic castrate-resistant prostate cancer; sodium fluoride; positron emission tomography-computed tomography; bone scans; metastasis detection; pet/ct scans
Journal Title: European Urology Focus
Volume: 3
Issue: 2-3
ISSN: 2405-4569
Publisher: European Association of Urology  
Date Published: 2017-04-01
Start Page: 223
End Page: 239
Language: English
DOI: 10.1016/j.euf.2016.06.018
PROVIDER: scopus
PUBMED: 28753774
DOI/URL:
Notes: Review -- Export Date: 2 January 2018 -- Source: Scopus
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  1. Evis Sala
    94 Sala