The oncologists’ unmet clinical needs for imaging in advanced prostate cancer

Abstract

The management of men with advanced prostate cancer has become a dynamic field due to the approval of several agents in the castration-resistant state of the disease (abiraterone acetate, enzalutamide, docetaxel, cabazitaxel, radium-223), the technical advances of radiation therapy (IMRT; stereotactic body radiation) and not at least due to significant innovations in the field of imaging modalities. Several distinct disease states of prostate cancer can be identified, with specific needs with regard to imaging modalities. The manuscript will discuss the following disease states: castration-naive metastatic prostate cancer, oligometastatic prostate cancer, castration-resistant prostate cancer (non-metastatic M0 and metastatic M1). Imaging in advanced prostate cancer generally consists of bone scintigraphy and contrast enhanced-computed tomography (CT). Increasingly more sophisticated technologies including multiparametric MRI, PET/CT (with different tracers) and hybrid PET/CT-MRI techniques are discussed and in larger centres available also outside of clinical trials. Many questions, however, are unsolved and as of now it is unclear whether the increased diagnostic sensitivity/specificity of these imaging technologies translates into a relevant clinical benefit for men with advanced prostate cancer in the sense of improvement of clinical outcome or guiding treatment decision. This opinion piece will reflect some of the areas of unmet needs in the management of men with advanced prostate cancer that oncologists face in daily practice as perceived by the authors.