Dr. Koo on Metastasis-Directed Therapy in Prostate Cancer

Phillip J. Koo, MD, division chief of Diagnostic Imaging, Banner MD Anderson Cancer Center, discusses the use of metastasis-directed therapy in prostate cancer.

Next-generation imaging modalities are better equipped to detect oligometastatic disease compared with conventional imaging tools, says Koo. For example, if a patient presents with biochemical recurrence and a low prostate-specific antigen of 0.5 ng/mL or 1 ng/mL, a bone scan or CT scan will likely be negative. However, if next-generation imaging is employed, there's a greater chance of detecting locally recurrent disease, local metastatic disease, or oligometastatic disease outside the pelvis, says Koo.

According to surveys and consensus meetings, such as the Advanced Prostate Cancer Consensus Conference, patients who are found to have oligometastatic disease should be treated with metastasis-directed therapy. The data supporting the impact of this approach is growing, adds Koo. For example, a study from The University of Ghent demonstrated that the time to initiation of androgen deprivation therapy was prolonged in patients who had a C11-choline PET/CT and then received radiation or surgery on identified lesions, concludes Koo.