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The urologist’s unmet clinical needs in prostate cancer

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Abstract

PET imaging represents an improvement in the diagnostic performance relative to conventional imaging, but several needs of the urologist are still unmet. The aim of this review is to identify limitations of currently available PET imaging and the resulting clinical consequences. Several relevant clinical settings of prostate cancer management where PET imaging is or could be used were identified. The current literature was then checked to match the currently reported performance based on PET imaging, with the clinical need to highlight current limitations. The most currently used tracers for prostate cancer are 18F-choline and 11C-choline, whereas other tracers such as Gallium-68 labeled prostate-specific membrane antigen (PSMA) and anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid are either experimental and/or not readily available. PET in the management of prostate cancer is of interest in any setting where cancer lesions should be identified, these are: search for the primary, initial staging, staging at recurrence and during treatment of metastatic disease. PET provides improved performance relative to conventional imaging but still has limitations. These are first associated to low quality and small studies including heterogeneous patients, making clear conclusions difficult. Moreover, there is lack of studies showing improved patient outcome and cost-effectiveness of pathways using PET. When it comes to specific clinical scenarios, PET has limited performance when used for the search of the primary or when used for the initial staging. Its most promising use is at the time point of biochemical recurrence. However, its performance at very early recurrences with low PSA levels remains limited. The use of PET needs to be explored for systemic treatment monitoring in metastatic patients. PET provides improved diagnostic performance relative to conventional imaging. Its most promising use is at the time point of biochemical recurrence after treatment with curative intent. In other clinical scenarios further improvements and research are necessary. It seems to be important to know the limitations of this imaging technology to truly improve the clinical decision making and to avoid waste of resources.

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Author information

Authors and Affiliations

  1. Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Bd Ste. Marguerite, 13009, Marseille, France

    Jochen Walz & Geraldine Pignot

  2. Department of Radiotherapy, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Naji Salem

  3. Department of Radiology, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Serge Brunelle

  4. Department of Medical Oncology, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Gwenaelle Gravis

  5. Department of Nuclear Medicine, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Isabelle Brenot-Rossi

Authors
  1. Jochen Walz
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  2. Geraldine Pignot
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  3. Naji Salem
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  4. Serge Brunelle
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  5. Gwenaelle Gravis
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  6. Isabelle Brenot-Rossi
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Correspondence to Jochen Walz.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Walz, J., Pignot, G., Salem, N. et al. The urologist’s unmet clinical needs in prostate cancer. Clin Transl Imaging 4, 433–438 (2016). https://doi.org/10.1007/s40336-016-0199-2

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  • DOI: https://doi.org/10.1007/s40336-016-0199-2

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