Dr. Koo on 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.