Optimum Imaging Strategies for Advanced Prostate Cancer

Published online January 15, 2020, DOI: 10.1200/JCO.19.02757

Edouard J. Trabulsi, R. Bryan Rumble, Hossein Jadvar, Thomas Hope, Martin Pomper, Baris Turkbey, Andrew B. Rosenkrantz, Sadhna Verma, Daniel J. Margolis, Adam Froemming, Aytekin Oto, Andrei Purysko, Matthew I. Milowsky, Heinz-Peter Schlemmer, Matthias Eiber, Michael J. Morris, Peter L. Choyke, Anwar Padhani, Jorge Oldan, Stefano Fanti, Suneil Jain, Peter A. Pinto, Kirk A. Keegan,  Christopher R. Porter, Jonathan A. Coleman, Glenn S. Bauman, Ashesh B. Jani, Jeffrey M. Kamradt, Westley Sholes, and H. Alberto Vargas

With panel representation from the American College of Radiology, American Society for Radiation Oncology, American Urological Association, Society of Abdominal Radiology, Society of Nuclear Medicine and Molecular Imaging, and the Society of Urologic Oncology. As of April 30, 2020, this ASCO Guideline has been endorsed by the American College of Radiology, the American Society for Radiation Oncology, Society of Nuclear Medicine and Molecular Imaging^a, and the Society of Urologic Oncology.

Purpose

Provide evidence-and expert-based recommendations for optimal use of imaging in advanced prostate cancer. Due to increases in research and utilization of novel imaging for advanced prostate cancer, this guideline is intended to outline techniques available and provide recommendations on appropriate use of imaging for specified patient subgroups.

Methods

An Expert Panel was convened with members from ASCO and the Society of Abdominal Radiology, American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology to conduct a systematic review of the literature and develop an evidence-based guideline on the optimal use of imaging for advanced prostate cancer. Representative index cases of various prostate cancer disease states are presented, including suspected high-risk disease, newly diagnosed treatment-naïve metastatic disease, suspected recurrent disease after local treatment, and progressive disease while undergoing systemic treatment. A systematic review of the literature from 2013 to August 2018 identified fully published English-language systematic reviews with or without meta-analyses, reports of rigorously conducted phase III randomized controlled trials that compared ≥ 2 imaging modalities, and noncomparative studies that reported on the efficacy of a single imaging modality.

Results

A total of 35 studies met inclusion criteria and form the evidence base, including 17 systematic reviews with or without meta-analysis and 18 primary research articles

Recommendations

One or more of these imaging modalities should be used for patients with advanced prostate cancer: conventional imaging (defined as computed tomography [CT], bone scan, and/or prostate magnetic resonance imaging [MRI]) and/or next-generation imaging (NGI), positron emission tomography [PET], PET/CT, PET/MRI, or whole-body MRI) according to the clinical scenario.

© 2019 American Society of Clinical Oncology, all rights reserved. For licensing opportunities, contact licensing@asco.org.

^a On March 28, 2020, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) endorsed these guidelines for advanced prostate cancer. The expert panel that developed the guidelines included SNMMI representatives, and the final guidelines were reviewed by the SNMMI Guidance Oversight Committee, as well as the Procedure Standards Committee. SNMMI did not otherwise have input into the development of these guidelines.

Guideline Disclaimer

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