Optimum imaging strategies for advanced prostate cancer: ASCO guidelines

  • Trabulsi EJ & al.
  • J Clin Oncol
  • 15 Jan 2020

  • Oncology guidelines update
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Takeaway

  • The American Society of Clinical Oncology (ASCO) has issued guidelines on optimum imaging strategies for advanced prostate cancer.

Key recommendations

  • All patients should receive conventional imaging (CI; defined as CT, bone scan, and/or prostate MRI) and/or next-generation imaging (NGI; defined as positron emission tomography or whole-body MRI) according to the clinical scenarios.
  • Newly diagnosed high-risk/very high risk localized disease:
    • When CI is negative, suspicious/equivocal, NGI may add clinical benefit.
  • Rising PSA after prostatectomy and negative CI:
    • Offer NGI if salvage radiotherapy is contemplated, but not for men who are ineligible or unwilling to receive salvage local/regional therapy.
  • Rising PSA after radiotherapy and negative CI:
    • NGI can be offered if salvage local/regional therapy is contemplated.
  • Hormone-sensitive metastatic disease at initial diagnosis or after initial treatment:
    • NGI may clarify the burden of disease.
  • Nonmetastatic castration-resistant disease:
    • NGI can be offered only if a change in clinical care is contemplated.
  • Metastatic castration-resistant disease:
    • PSA progression alone should not be the sole reason to change therapy; CI can be used for initial evaluation and should be continued to facilitate changes.
    • NGI may be used in an individualized manner when subclinical metastasis is suspected despite negative CI.
  • Radiographic progression on CI:
    • NGI should not be routinely offered.