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The oncologists’ unmet clinical needs for imaging in advanced prostate cancer

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Abstract

The management of men with advanced prostate cancer has become a dynamic field due to the approval of several agents in the castration-resistant state of the disease (abiraterone acetate, enzalutamide, docetaxel, cabazitaxel, radium-223), the technical advances of radiation therapy (IMRT; stereotactic body radiation) and not at least due to significant innovations in the field of imaging modalities. Several distinct disease states of prostate cancer can be identified, with specific needs with regard to imaging modalities. The manuscript will discuss the following disease states: castration-naïve metastatic prostate cancer, oligometastatic prostate cancer, castration-resistant prostate cancer (non-metastatic M0 and metastatic M1). Imaging in advanced prostate cancer generally consists of bone scintigraphy and contrast enhanced-computed tomography (CT). Increasingly more sophisticated technologies including multiparametric MRI, PET/CT (with different tracers) and hybrid PET/CT-MRI techniques are discussed and in larger centres available also outside of clinical trials. Many questions, however, are unsolved and as of now it is unclear whether the increased diagnostic sensitivity/specificity of these imaging technologies translates into a relevant clinical benefit for men with advanced prostate cancer in the sense of improvement of clinical outcome or guiding treatment decision. This opinion piece will reflect some of the areas of unmet needs in the management of men with advanced prostate cancer that oncologists face in daily practice as perceived by the authors.

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Authors and Affiliations

  1. Department of Oncology and Haematology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland

    Aurelius Omlin & Silke Gillessen

  2. Departments of Radiology and Nuclear Medicine, Cantonal Hospital St.Gallen, St.Gallen, Switzerland

    Joachim Mueller

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  1. Aurelius Omlin
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  2. Joachim Mueller
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  3. Silke Gillessen
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Correspondence to Aurelius Omlin.

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The following conflicts of interest have to be reported: AO advisory boards (compensated, institutional): Bayer, Astellas, Janssen, Sanofi, Pfizer. Travel support: Bayer, Astellas, Janssen, Sanofi. JM: no conflicts of interest. SG: advisory boards (compensated institutional) Astellas, Bayer, Curevac, Dendreon, Janssen Cilag, Janssen Diagnostics, Millennium, Novartis, Orion Pharma, Pfizer, Sanofi Aventis. Advisory Boards (uncompensated): ProteoMediX, ESSA Pharmaceuticals Corp. Speakers Bureau (without honorarium): Amgen, Astellas, Bayer, Janssen Cilag, Sanofi Aventis. Patent: Pending patent application for a method for biomarker WO 2009138392 A1.

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Omlin, A., Mueller, J. & Gillessen, S. The oncologists’ unmet clinical needs for imaging in advanced prostate cancer. Clin Transl Imaging 4, 423–431 (2016). https://doi.org/10.1007/s40336-016-0204-9

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