Abstract
Metastasized castration-resistant prostate cancer (mCRPC), is the most advanced form of prostate neoplasia, where massive spread to the skeletal tissue is frequent. Patients with this condition are benefiting from an increasing number of treatment options. However, assessing tumor response in patients with multiple localizations might be challenging. For this reason, many computational approaches have been developed in the last decades to quantify the skeletal tumor burden and treatment response. In this review, we analyzed the progressive development and diffusion of such approaches. A computerized literature search of the PubMed/Medline was conducted, including articles between January 2008 and March 2018. The search was expanded by manually reviewing the reference list of the chosen articles. Thirty-five studies were identified. The number of eligible studies greatly increased over time. Studies could be categorized in the following categories: automated analysis of 2D scans, SUV-based thresholding, hybrid CT- and SUV-based thresholding, and MRI-based thresholding. All methods are discussed in detail. Automated analysis of bone tumor burden in mCRPC is a growing field of research; when choosing the appropriate method of analysis, it is important to consider the possible advantages as well as the limitations thoroughly.
Highlights
Prostate cancer is the most common non-cutaneous neoplasia in western countries, affecting up to one in five individuals, with incidence increasing with age [1]
Once considered as a harbinger of terminal disease, today bone metastases can be treated with a variety of modalities, including anti-androgen, cytotoxic, immune, and radioisotope therapy [2,4,5,6,7]
The presence and extension of bone metastases are investigated with imaging methods [10]: these techniques include the identification of increased mineral density, of bone turnover, as well as the characterization of the prostate-specific transmembrane antigen using PSMA-PET
Summary
Prostate cancer is the most common non-cutaneous neoplasia in western countries, affecting up to one in five individuals, with incidence increasing with age [1]. The presence and extension of bone metastases are investigated with imaging methods [10]: these techniques include the identification of increased mineral density (at X-ray computed tomography), of bone turnover (afforded by bone scan or by fluoride PET/CT), as well as the characterization of the prostate-specific transmembrane antigen using PSMA-PET. While these methods can identify the characteristics associated with the presence of bone metastases, an accurate estimation of the total tumor burden is challenging, especially in patients with extensive metastastization. We are going to analyze the computational methods currently available or in development, to identify the advantages and the disadvantage of each one of them, in order to clarify which of these methods is the most promising for current mCRPC patient care
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