Dr. Koo on the Actionability of Next-Generation Imaging Results in Prostate Cancer

January 29, 2020
Phillip J. Koo, MD

Phillip J. Koo, MD, division chief of Diagnostic Imaging, Banner MD Anderson Cancer Center, discusses the actionability of next-generation imaging results in prostate cancer.

Phillip J. Koo, MD, division chief of Diagnostic Imaging at Banner MD Anderson Cancer Center, discusses the actionability of next-generation imaging results in prostate cancer.

The results of next-generation imaging tests should be actionable in order to be valuable, says Koo. As such, prior to ordering a test, it should be known how the information could influence treatment decisions.

According to a trial that enrolled a SPARTAN-like population, 55% of patients with nonmetastatic castration-resistant prostate cancer (CRPC) had N1 disease when they were scanned with prostate-specific membrane antigen. Notably, those patients were included in the phase III SPARTAN trial based on conventional imaging with a bone scan and CT and still derived a 2-year improvement in metastasis-free survival.

Although next-generation imaging modalities have higher sensitivity compared with conventional imaging, it’s important to adhere to the data and use next-generation imaging where appropriate, says Koo.

Patients with CRPC have aggressive disease. Prostate-specific antigen (PSA) is an important biomarker, but patients can progress without a rise in PSA. According to data from the PREVAIL trial, 25% of patients have radiographic progression without a rise in PSA; these patients may be candidates for monitoring with next-generation imaging, concludes Koo.

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