scholarly journals Bone scan use in the management of metastatic castration-resistant prostate cancer: Survey of practice patterns among Canadian radiation oncologists, medical oncologists, and urologists

2020 ◽  
Vol 14 (11) ◽  
Author(s):  
Mahbuba Meem ◽  
Katherine Zukotynski ◽  
Srinivas Raman ◽  
Urban Emmenegger
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Bone Scan ◽  
Imaging Techniques ◽  
Therapeutic Interventions ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Positron Emission ◽  
Psma Pet ◽  
Bone Scans

The use of skeletal scintigraphy with technetium-99 methylene diphosphonate (hereafter referred to as a bone scan) for evaluating response to systemic treatment in men with metastatic castration-resistant prostate cancer (mCRPC) is an evolving paradigm in this era of advancing therapies and imaging techniques. Indeed, the interpretation of bone scans can be challenging, and there is a growing expectation that advanced imaging techniques such as prostate-specific membrane antigen positron emission tomography/computer tomography (PSMA PET/CT) may play a complementary role.1 The Prostate Cancer Working Group (PCWG) has outlined specific criteria to define disease progression with respect to bone scans performed as part of clinical trials.2 However, there is no high-level evidence for the scheduling and interpretation of bone scans during routine therapeutic interventions for mCRPC. Thus, patterns of bone scan use are variable and practice-dependent outside of clinical trials.

The Prostate Cancer Clinical Trials Working Group (PCCTWG) consensus criteria for phase II clinical trials for castration-resistant prostate cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5057-5057 ◽  
Author(s):  
H. I. Scher ◽  
S. Halabi ◽  
I. Tannock ◽  
M. Morris ◽  
C. Higano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Bone Scan ◽  
Clinical Manifestations ◽  
Disease Assessment ◽  
Phase 2 ◽  
Castration Resistant Prostate Cancer ◽  
Time To Event ◽  
Phase 3 ◽  
Castration Resistant

5057 Background: The clinical manifestations of castration-resistant metastatic prostate cancer pose challenges to the design of phase 2 trials. In 1999, PSAWG issued a consensus report to standardize phase 2 design and endpoint definitions. A reassessment is reported. Methods: At 4 meetings, and using electronic communication, PCCTWG is seeking consensus on the design and analysis of phase 2 trials that can inform decisions about proceeding to phase 3. Results: PCCTWG recognizes that trial objectives, and details of design and analysis depend on the agent under study. PCCTWG recommends: (i) A standard disease assessment that includes prior treatment history, bone scan, and CT of the chest, abdomen and pelvis; (ii) Revision of eligibility criteria to lower PSA thresholds and serum testosterone levels; (iii) Emphasis on time-to-event endpoints including clinical, biochemical (e.g. PSA) or radiologic progression, recognizing that molecular targeted agents may delay progression without influencing initial response. (iv) Independent reporting of biochemical, radiographic, and clinical outcomes, avoiding grouped categorizations of complete or partial response, or stable disease. (v) Treating for a minimum of 12 weeks before assessing disease status, as the onset of PSA declines are often delayed, verifying that an agent does not influence release of PSA from cells. (vi) RECIST criteria are appropriate for changes in measurable disease, separating nodal and visceral sites. (vii) Changes in bone scan should be reported as “new lesions” or “no new lesions”, confirming findings of progression on a second scan. (viii) Pain and analgesic intake should be assessed using validated scales. (ix) Due to inherent variability, randomization to experimental and control groups is preferred, and innovative designs, e.g. expanding selected arms of randomized phase 2 trials to phase 3. Conclusions: PCCTWG recommends increasing emphasis on time to event endpoints as decision aids in proceeding from phase 2 to phase 3 trials. The recommendations will evolve as data are generated from phase 3 studies on the ability of intermediate endpoints to predict for clinical benefit. Support: MSKCC SPORE (CA 92629), Prostate Cancer Foundation. No significant financial relationships to disclose.

Clinical impact of whole-body 68Ga-PSMA I&T PET/CT: lesion frequency and added benefit in lower extremities

2021 ◽  
Vol 60 (06) ◽  
pp. 417-424
Author(s):  
Lara Franziska Stolzenbach ◽  
Florian Löcherbach ◽  
Tobias Maurer ◽  
Christoph Berliner ◽  
Katharina Wargenau ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lower Extremities ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Castration Resistant Prostate Cancer ◽  
Systematic Analysis ◽  
Castration Resistant ◽  
Positron Emission ◽  
Psma Pet ◽  
Pet Ct

Abstract Aim Few small-scaled studies performed systematic analysis of the benefits of extending prostate specific membrane antigen positron-emission tomography/ computed tomography (68Ga-PSMA I&T PET/CT) to the lower extremities in prostate cancer (PCa) patients. We hypothesized that 68Ga-PSMA I&T PET/CT positive lesions are rare in lower extremities of prostate cancer (PCa) patients, the clinical implication is negligible and may therefore be omitted. Methods We retrospectively analyzed 1,068 PCa patients who received 68Ga-PSMA I&T PET/CT in a single institution (2016–2018). Of those, 285 (26.7%) were newly diagnosed, 529 (49.5%) had biochemical recurrence (BCR) and 254 (23.8%) were castration-resistant prostate cancer (CRPC) patients. Results Of 1,068 68Ga-PSMA I&T PET/CTs, positive lesions in the lower extremities were identified in 6.9% patients (n=74). Positive lesions in the lower extremities were most common in CRPC patients (19.7%; n=50), followed by newly diagnosed (3.2%; n=9) and BCR (2.8%; n=15) PCa patients. Only 3 patients presented with exclusive lesions in the lower extremities, respectively 0.8% (n=2) in CRPC and 0.4% (n=1) in newly diagnosed PCa. Both CRPC (94.1%, n=47) and BCR (80.0%, n=12) patients with PSMA-positive lesions predominantly received systemic therapy. Conclusion Identification of lower extremities lesions with PSMA PET/CT is uncommon and exclusive lesions are rare. PSMA PET/CT findings of the lower extremities did not change therapy management. Thus, scanning of the lower extremities can be omitted in standard protocols.

scholarly journals Treatment of nonmetastatic castration-resistant prostate cancer: focus on second-generation androgen receptor inhibitors

2021 ◽  
Author(s):  
Fred Saad ◽  
Martin Bögemann ◽  
Kazuhiro Suzuki ◽  
Neal Shore
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Second Generation ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Conventional Imaging ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Therapeutic Decisions ◽  
Consensus Statements

Abstract Background Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as a rising prostate-specific antigen concentration, despite castrate levels of testosterone with ongoing androgen-deprivation therapy or orchiectomy, and no detectable metastases by conventional imaging. Patients with nmCRPC progress to metastatic disease and are at risk of developing cancer-related symptoms and morbidity, eventually dying of their disease. While patients with nmCRPC are generally asymptomatic from their disease, they are often older and have chronic comorbidities that require long-term concomitant medication. Therefore, careful consideration of the benefit–risk profile of potential treatments is required. Methods In this review, we will discuss the rationale for early treatment of patients with nmCRPC to delay metastatic progression and prolong survival, as well as the factors influencing this treatment decision. We will focus on oral pharmacotherapy with the second-generation androgen receptor inhibitors, apalutamide, enzalutamide, and darolutamide, and the importance of balancing the clinical benefit they offer with potential adverse events and the consequential impact on quality of life, physical capacity, and cognitive function. Results and conclusions While the definition of nmCRPC is well established, the advent of next-generation imaging techniques capable of detecting hitherto undetectable oligometastatic disease in patients with nmCRPC has fostered debate on the criteria that inform the management of these patients. However, despite these developments, published consensus statements have maintained that the absence of metastases on conventional imaging suffices to guide such therapeutic decisions. In addition, the prolonged metastasis-free survival and recently reported positive overall survival outcomes of the three second-generation androgen receptor inhibitors have provided further evidence for the early use of these agents in patients with nmCRPC in order to delay metastases and prolong survival. Here, we discuss the benefit–risk profiles of apalutamide, enzalutamide, and darolutamide based on the data available from their pivotal clinical trials in patients with nmCRPC.

scholarly journals Development of a preliminary nomogram to predict progression of bone scan for castration-resistant prostate cancer

2015 ◽  
pp. 713
Author(s):  
Dingwei Ye ◽  
Guo-wen Lin ◽  
Hui-Xun Jia ◽  
Bo Dai ◽  
Hai-Liang Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Scan ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant

scholarly journals Overview of the Development and Use of Akt Inhibitors in Prostate Cancer

2021 ◽  
Vol 11 (1) ◽  
pp. 160
Author(s):  
Anis Gasmi ◽  
Guilhem Roubaud ◽  
Charles Dariane ◽  
Eric Barret ◽  
Jean-Baptiste Beauval ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Phase Ii ◽  
Critical Role ◽  
Castration Resistant Prostate Cancer ◽  
Loss Of Function ◽  
Pten Loss ◽  
Castration Resistant ◽  
Recent Phase ◽  
Phase Ii And Iii

Deregulation of the PI3K-Akt-mTOR pathway plays a critical role in the development and progression of many cancers. In prostate cancer, evidence suggests that it is mainly driven by PTEN loss of function. For many years, the development of selective Akt inhibitors has been challenging. In recent phase II and III clinical trials, Ipatasertib and Capivasertib associated with androgen deprivation therapies showed promising outcomes in patients with metastatic castration-resistant prostate cancer and PTEN-loss. Ongoing trials are currently assessing several Akt inhibitors in prostate cancer with different combinations, at different stages of the disease.

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