The Future of Imaging in Prostate Cancer

"Prostate cancer has recently experienced major breakthroughs in diagnostic techniques with novel imaging strategies in the context of recurrent disease or elevated serum prostate-specific antigen (PSA) levels. Specifically, 18F fluciclovine was approved by the US Food and Drug Administration in 2016, and 68Ga PSMA-11 was approved at the end of 2020. In Future Oncology July 2021, Dr Philip J. Koo and Dr Daniel Petrylak published the summary of a December 2020 panel discussion —part of the Emerging Paradigms in Care Series (EPICS)—on this rapidly evolving treatment landscape.

Overall, the approval of 68Ga PSMA-11 has generated substantial enthusiasm as a new imaging agent and because it offers an additional approach to detect metastatic disease. It has a broader indication than 18F fluciclovine, including patients with suspected metastases who are candidates for initial definite therapy. The 40% sensitivity rate of Ga PSMA-11 in patients with intermediate- to high-risk prostate cancer is substantially higher than the limited sensitivity achieved by conventional techniques. Although current literature shows general favor for prostate-specific membrane antigen (PSMA)-based agents rather than fluciclovine for initial staging and to detect biochemical recurrence (BCR), it remains unclear how PSMA imaging will impact the use of fluciclovine scans. Some experts suggest that the answer may depend on various factors, such as comfort level with the tool, access, and reimbursement. Overall, the panel perceives Ga PSMA-11 to be more sensitive, but prefers fluciclovine for detecting local disease and neuroendocrine histologies..." Lire la suite