Next-generation Imaging Research Articles

Probing the cosmic web in Lyα emission over large scales: an intensity mapping forecast for DECaLS/BASS and DESI

ABSTRACT Being the most prominent H i line, Ly$\alpha$ permeates the cosmic web in emission. Despite its potential as a cosmological probe, its detection on large scales remains elusive. We present a new methodology to perform Ly$\alpha$ intensity mapping with broad-band optical images, by cross-correlating them with Ly$\alpha$ forest data using a custom one-parameter estimator. We also develop an analytical large-scale Ly$\alpha$ emission model with two parameters (average luminosity $\langle L_{\rm Ly\alpha } \rangle$ and bias $b_{\rm e}$) that respects observational constraints from quasar (QSO) luminosity functions. We compute a forecast for Dark Energy Camera Legacy Survey (DECaLS)/Beijing–Arizona Sky Survey (BASS) g-band images cross-correlated with Dark Energy Spectroscopic Instrument (DESI) Ly$\alpha$ forest data, setting guidelines for reducing images into Ly$\alpha$ intensity maps. Given the transversal scales of our cross-correlation (26.4 arcmin, $\sim$33 cMpc h−1), our study effectively integrates Ly$\alpha$ emission over all the cosmic volume inside the DESI footprint at $2.2 \lt z \lt 3.4$ (the g-band Ly$\alpha$ redshift range). Over the parameter space ($\langle L_{\rm Ly\alpha } \rangle$, $b_{\rm e}$) sampled by our forecast, we find a 3$\sigma$ of large-scale structure in Ly$\alpha$ likely, with a probability of detection of 23.95 per cent for DESI–DECaLS/BASS, and 54.93 per cent for a hypothetical DESI phase-II with twice as much Ly$\alpha$ QSOs. Without a detection, we derive upper bounds on $\langle L_{\rm Ly\alpha } \rangle$ competitive with optimistic literature estimates [$2.3 \pm 1 \times 10^{\rm 41}$ erg s−1 (cMpc$^3$)−1 for DESI, and $\sim$35 per cent lower for its hypothetical phase-II]. Extrapolation to the DESI-Rubin overlap shows that a detection of large-scale structure with Ly$\alpha$ intensity mapping using next-generation imaging surveys is certain. Such detection would allow constraining $\langle L_{\rm Ly\alpha } \rangle$, and explore the constraining power of Ly$\alpha$ intensity mapping as a cosmological probe.

Imaging assessment of prostate cancer recurrence: advances in detection of local and systemic relapse.

Prostate cancer (PCa) relapse, defined either by persistent PSA levels (after RP) or biochemical recurrence (BCR), is a common occurrence. The imaging evaluation of patients experiencing PCa relapse has undergone significant advancements in the past decade, notably with the introduction of new Positron Emission Tomography (PET) tracers such as Prostate-specific membrane antigen (PSMA), and the progress in functional Magnetic Resonance Imaging (MRI). This article will explore the role of traditional imaging, the evolution of MRI towards the development of the Prostate Magnetic Resonance Imaging for Local Recurrence Reporting (PI-RR) scoring system, and how next-generation imaging is enhancing diagnostic accuracy in the setting of PCa relapse, which is essential for adopting personalized strategies that may ultimately impact outcomes.

Detection prospects of very and ultra high-energy gamma rays from extended sources with ASTRI, CTA, and LHAASO

Context. The recent discovery of several ultra high-energy gamma-ray emitters in our Galaxy represents a significant advancement towards the characterisation of its most powerful accelerators. Nonetheless, in order to unambiguously locate the regions where the highest energy particles are produced and understand the responsible physical mechanisms, detailed spectral and morphological studies are required, especially given that most of the observed sources were found to be significantly extended. Aims. In these regards, pointing observations with the next-generation Imaging Atmospheric Cherenkov Telescopes, such as the Cherenkov Telescope Array (CTA) Observatory and the ASTRI Mini-Array (ASTRI), are expected to provide significant improvements. Here we aim to identify the most promising sources to target in future observations. Methods. For this purpose, we performed a comparative analysis of the expected performance of ASTRI and CTA, computing their differential sensitivities towards extended sources, and further explored their capabilities with respect to specific case studies, including follow-ups of existing gamma-ray source catalogues. Results. We find that almost all of the sources thus far detected by LHAASO-WCDA and in the H.E.S.S. Galactic Plane Survey will be in the reach of ASTRI and CTA with about 300 and 50 hours of exposure, respectively. For the highest energy emitters detected by LHAASO-KM2A, in turn, we provide a list of the most promising objects that would require further investigation. We additionally examined specific classes of sources in order to identify potentially detectable gamma-ray emitters, such as passive molecular clouds (i.e. illuminated by the cosmic-ray sea) and pulsars surrounded by a halo of runaway particles.

Advancements in Nanoporous Materials for Biomedical Imaging and Diagnostics.

This review explores the latest advancements in nanoporous materials and their applications in biomedical imaging and diagnostics. Nanoporous materials possess unique structural features, including high surface area, tunable pore size, and versatile surface chemistry, making them highly promising platforms for a range of biomedical applications. This review begins by providing an overview of the various types of nanoporous materials, including mesoporous silica nanoparticles, metal-organic frameworks, carbon-based materials, and nanoporous gold. The synthesis method for each material, their current research trends, and prospects are discussed in detail. Furthermore, this review delves into the functionalization and surface modification techniques employed to tailor nanoporous materials for specific biomedical imaging applications. This section covers chemical functionalization, bioconjugation strategies, and surface coating and encapsulation methods. Additionally, this review examines the diverse biomedical imaging techniques enabled by nanoporous materials, such as fluorescence imaging, magnetic resonance imaging (MRI), computed tomography (CT) imaging, ultrasound imaging, and multimodal imaging. The mechanisms underlying these imaging techniques, their diagnostic applications, and their efficacy in clinical settings are thoroughly explored. Through an extensive analysis of recent research findings and emerging trends, this review underscores the transformative potential of nanoporous materials in advancing biomedical imaging and diagnostics. The integration of interdisciplinary approaches, innovative synthesis techniques, and functionalization strategies offers promising avenues for the development of next-generation imaging agents and diagnostic tools with enhanced sensitivity, specificity, and biocompatibility.

Multiparametric Whole-Body MRI: A Game Changer in Metastatic Prostate Cancer.

Prostate cancer ranks among the most prevalent tumours globally. While early detection reduces the likelihood of metastasis, managing advanced cases poses challenges in diagnosis and treatment. Current international guidelines support the concurrent use of 99Tc-Bone Scintigraphy and Contrast-Enhanced Chest and Abdomen CT for the staging of metastatic disease and response assessment. However, emerging evidence underscores the superiority of next-generation imaging techniques including PSMA-PET/CT and whole-body MRI (WB-MRI). This review explores the relevant scientific literature on the role of WB-MRI in metastatic prostate cancer. This multiparametric imaging technique, combining the high anatomical resolution of standard MRI sequences with functional sequences such as diffusion-weighted imaging (DWI) and bone marrow relative fat fraction (rFF%) has proved effective in comprehensive patient assessment, evaluating local disease, most of the nodal involvement, bone metastases and their complications, and detecting the increasing visceral metastases in prostate cancer. It does have the advantage of avoiding the injection of contrast medium/radionuclide administration, spares the patient the exposure to ionizing radiation, and lacks the confounder of FLARE described with nuclear medicine techniques. Up-to-date literature regarding the diagnostic capabilities of WB-MRI, though still limited compared to PSMA-PET/CT, strongly supports its widespread incorporation into standard clinical practice, alongside the latest nuclear medicine techniques.

Real-world economic burden associated with disease progression from metastatic castration-sensitive to castration-resistant prostate cancer on treatment in the United States.

The advent of next-generation imaging will likely reduce nonmetastatic prostate cancer (PC) prevalence and increase identification of metastatic prostate cancer cases, resulting in two predominant advanced stages in the metastatic setting. There is a need to characterize changes in health care resource utilization (HRU) and costs when metastatic castration-sensitive PC (mCSPC) progresses to metastatic castration-resistant PC (mCRPC) to identify value drivers from current and new treatments. To describe treatment patterns, HRU, and total health care costs among patients with mCSPC, before and after progression to mCRPC. Clinical data from the Flatiron Metastatic PC Core Registry (January 1, 2013, to December 1, 2021) and linked claims from Komodo Health (January 1, 2014, to December 1, 2021) were used to identify patients with progression from mCSPC to mCRPC (date of progression was the index date) and subsequently initiated first-line mCRPC therapy on/after January 1, 2017. Treatment patterns and all-cause/PC-related HRU and health care costs were described per-patient-per-month (PPPM), separately for no more than 12 months pre-index (mCSPC disease state) and post-index (mCRPC disease state). Costs (payer's perspective) included those for services/procedures from medical claims and costs from pharmacy claims. Continuous HRU and costs were compared between the mCSPC and mCRPC disease states using Wilcoxon signed rank tests. Among 296 patients with mCSPC progressing to mCRPC (median age 69.0 years, 60.5% White, 15.9% Black), use of systemic therapies with androgen deprivation therapy increased dramatically from 35.1% in the mCSPC disease state to 92.9% in the mCRPC disease state, and use of androgen deprivation therapy monotherapy decreased from 25.7% to 2.4%, respectively. Although 39.2% received none of these therapies in the mCSPC disease state, this proportion decreased to 4.7% after transition to mCRPC. The mean number of days with PC-related outpatient visits increased from 1.57 to 2.16 PPPM in the mCSPC and mCRPC disease states (P < 0.001). From the mCSPC to mCRPC disease states, mean all-cause total health care costs PPPM increased from $4,424 (medical costs: $2,846) to $9,717 (medical costs: $4,654), and mean PC-related total health care costs PPPM increased from $2,859 (medical costs: $1,626) to $8,012 (medical costs: $3,285; all P < 0.001). In this real-world study of patients with disease progression from mCSPC to mCRPC in US clinical practice, nearly 2-in-3 patients did not receive treatment with additional systemic therapies before progression to castration resistance. Post-progression, mean PC-related total costs increased nearly 3-fold, with a more than 2-fold increase in PC-related medical costs. Use of additional systemic therapies may delay the time and cost associated with disease progression to castration resistance.

Sandwiched WS2/MoTe2/WS2 Heterostructure with a Completely Depleted Interlayer for a Photodetector with Outstanding Detectivity.

Photodetectors based on two-dimensional van der Waals (2D vdW) heterostructures with high detectivity and rapid response have emerged as promising candidates for next-generation imaging applications. However, the practical application of currently studied 2D vdW heterostructures faces challenges related to insufficient light absorption and inadequate separation of photocarriers. To address these challenges, we present a sandwiched WS2/MoTe2/WS2 heterostructure with a completely depleted interlayer, integrated on a mirror electrode, for a highly efficient photodetector. This well-designed structure enhances light-matter interactions while facilitating effective separation and rapid collection of photocarriers. The resulting photodetector exhibits a broadband photoresponse spanning from deep ultraviolet to near-infrared wavelengths. When operated in self-powered mode, the device demonstrates an exceptional response speed of 22/34 μs, along with an impressive detectivity of 8.27 × 1010 Jones under 635 nm illumination. Additionally, by applying a bias voltage of -1 V, the detectivity can be further increased to 1.49 × 1012 Jones, while still maintaining a rapid response speed of 180/190 μs. Leveraging these outstanding performance metrics, high-resolution visible-near-infrared light imaging has been successfully demonstrated using this device. Our findings provide valuable insights into the optimization of device architecture for diverse photoelectric applications.

Improved constraints on hematite refractive index for estimating climatic effects of dust aerosols

Uncertainty in desert dust composition poses a big challenge to understanding Earth’s climate across different epochs. Of particular concern is hematite, an iron-oxide mineral dominating the solar absorption by dust particles, for which current estimates of absorption capacity vary by over two orders of magnitude. Here, we show that laboratory measurements of dust composition, absorption, and scattering provide valuable constraints on the absorption potential of hematite, substantially narrowing its range of plausible values. The success of this constraint is supported by results from an atmospheric transport model compared with station-based measurements. Additionally, we identify substantial bias in simulating hematite abundance in dust aerosols with current soil mineralogy descriptions, underscoring the necessity for improved data sources. Encouragingly, the next-generation imaging spectroscopy remote sensing data hold promise for capturing the spatial variability of hematite. These insights have implications for enhancing dust modeling, thus contributing to efforts in climate change mitigation and adaptation.

PSA Outcomes and Clinical Surveillance Among Patients With Nonmetastatic Castration-Resistant Prostate Cancer Treated With a Next-Generation Androgen Receptor Inhibitor in Urology Practices With or Without In-Office Dispensing

This retrospective study used electronic medical record data from community-based urology practices in the US (February 1, 2017, to September 17, 2021) to describe prostate-specific antigen (PSA) outcomes and clinical sur­veillance patterns among patients with nonmetastatic castration-resistant pros­tate cancer (nmCRPC) receiving next-generation androgen receptor inhibitors (ARIs) with or without in-office dispensing (IOD) services. Patients who were prescribed apalutamide, darolutamide, or enzalutamide were classified in IOD+ (IOD access + fill), IOD– (IOD access + no fill), or non-IOD cohorts (no IOD ac­cess). Outcomes were described by cohort from 14 days following initial prescrip­tion to the earliest of initiation of a new ARI or advanced prostate cancer medi­cation, end of clinical activity, or end of data availability. In total, 3300 patients were included (IOD+: n = 615; IOD–: n = 2474; non-IOD: n = 211). PSA response defined as a decline ≥50% from the baseline PSA value (PSA50) achieved by 6 and 12 months was observed in 80.0% and 83.8% of patients in the IOD+ cohort, 63.8% and 72.3% in the IOD– cohort, and 62.5% and 69.1% in the non-IOD cohort. Patients in the IOD+ cohort underwent fewer bone scans, computerized tomog­raphy, and next-generation imaging than IOD– and non-IOD cohorts and also had longer time from treatment initiation to first follow-up imaging. IOD services may better support comprehensive disease management for patients with nmCRPC receiving next-generation ARIs and may be associated with better long-term clin­ical outcomes.

Halide perovskite x-ray detectors: Fundamentals, progress, and outlook

Halide perovskites have demonstrated great potential in x-ray detectors, due to their high x-ray attenuation coefficient, large bulk resistance, ultralong carrier diffusion length, and adjustable bandgap. Moreover, their abundant raw materials and simple processing combined with excellent compatibility with integrated circuits make them ideal for cost-efficient and high-efficiency real-world imaging applications. Herein, we comprehensively reviewed advances and progress in x-ray detection devices based on halide perovskites. We expound on the fundamental mechanisms of interactions between x rays and matter as background and indicate different parameters for different types of x-ray detectors, which guides the basic requirements on how to select and design suitable materials for active layers. After emphasizing the superb properties of halide perovskites through the shortcomings of commercial materials, we evaluate the latest advancements and ongoing progress in halide perovskites with different dimensions and structures for both direct and indirect x-ray detectors, and discuss the effect of dimensional varieties on the device performance. We also highlight current challenges in the area of perovskite x-ray detectors and propose corresponding solutions to optimize halide perovskites and optimize x-ray detectors for next-generation imaging applications.

2114: Next-generation imaging to set patient-tailored management of post-prostatectomy biochemical relapse

2114: Next-generation imaging to set patient-tailored management of post-prostatectomy biochemical relapse

Management of advanced prostate cancer in the Asia-Pacific region: Summary of the Asia-Pacific Advanced Prostate Cancer Consensus Conference 2023.

The aim of the third Asia-Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2023) was to discuss the application in the Asia-Pacific (APAC) region of consensus statements from the 4th Advanced Prostate Cancer Consensus Conference (APCCC 2022). The one-day meeting in July 2023 brought together 27 experts from 14 APAC countries. The meeting covered five topics: (1) Intermediate- and high-risk and locally advanced prostate cancer; (2) Management of newly diagnosed metastatic hormone-sensitive prostate cancer; (3) Management of non-metastatic castration-resistant prostate cancer; (4) Homologous recombination repair mutation testing; (5) Management of metastatic castration-resistant prostate cancer. Pre- and post-symposium polling gathered APAC-specific responses to APCCC consensus questions and insights on current practices and challenges in the APAC region. APAC APCCC highlights APAC-specific considerations in an evolving landscape of diagnostic technologies and treatment innovations for advanced prostate cancer. While new technologies are available in the region, cost and reimbursement continue to influence practice significantly. Individual patient considerations, including the impact of chemophobia on Asian patients, also influence decision-making. The use of next-generation imaging, genetic testing, and new treatment combinations is increasing the complexity and duration of prostate cancer management. Familiarity with new diagnostic and treatment options is growing in the APAC region. Insights highlight the continued importance of a multidisciplinary approach that includes nuclear medicine, genetic counseling, and quality-of-life expertise. The APAC APCCC meeting provides an important opportunity to share practice and identify APAC-specific issues and considerations in areas of low evidence where clinical experience is growing.

How Imaging Advances Are Defining the Future of Precision Radiation Therapy.

Radiation therapy is fundamental in the treatment of cancer. Imaging has always played a central role in radiation oncology. Integrating imaging technology into irradiation devices has increased the precision and accuracy of dose delivery and decreased the toxic effects of the treatment. Although CT has become the standard imaging modality in radiation therapy, the development of recently introduced next-generation imaging techniques has improved diagnostic and therapeutic decision making in radiation oncology. Functional and molecular imaging techniques, as well as other advanced imaging modalities such as SPECT, yield information about the anatomic and biologic characteristics of tumors for the radiation therapy workflow. In clinical practice, they can be useful for characterizing tumor phenotypes, delineating volumes, planning treatment, determining patients' prognoses, predicting toxic effects, assessing responses to therapy, and detecting tumor relapse. Next-generation imaging can enable personalization of radiation therapy based on a greater understanding of tumor biologic factors. It can be used to map tumor characteristics, such as metabolic pathways, vascularity, cellular proliferation, and hypoxia, that are known to define tumor phenotype. It can also be used to consider tumor heterogeneity by highlighting areas at risk for radiation resistance for focused biologic dose escalation, which can impact the radiation planning process and patient outcomes. The authors review the possible contributions of next-generation imaging to the treatment of patients undergoing radiation therapy. In addition, the possible roles of radio(geno)mics in radiation therapy, the limitations of these techniques, and hurdles in introducing them into clinical practice are discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Next-Generation Imaging Methodology: An Intelligent Transportation System for Consumer Industry

Next-Generation Imaging Methodology: An Intelligent Transportation System for Consumer Industry

A 1T'-MoTe2/GaN van der Waals Schottky junction for self-powered UV imaging and optical communication.

Schottky-type self-powered UV photodetectors are promising for next-generation imaging systems. Nevertheless, conventional device fabrication using high-energy metal deposition brings unintentional interface defects, leading to deteriorated device performance and inhomogeneities. Emerging two-dimensional (2D) metallic materials offer an alternative pathway to overcoming such limitations because of their naturally passivated surfaces and the ease of combining with mature bulk semiconductors via van der Waals (vdW) integration. Here, we report the controllable preparation of MoTe2 in the pure 1T' phase and the fabrication of a high-performance 1T'-MoTe2/GaN vdW Schottky photodiode. With the reduced interface states and suppressed dark current as low as 20 pA at zero bias, the photodiode exhibits a remarkable UV-to-visible (R350/R400) rejection ratio of 1.6 × 104, a stable photoresponsivity of ∼50 mA W-1 and a detectivity of 3.5 × 1012 Jones under 360 nm illumination. The photocurrent ON/OFF ratio reaches ∼4.9 × 106 under 10.5 mW irradiation (360 nm). In particular, the 1T'-MoTe2/GaN Schottky diode shows excellent weak-light detection capability, which could detect a 3 nW 360 nm laser and the light emission from a lighter with a pronounced Ilight/Idark ratio of ∼2. Finally, the applications of the device in self-powered UV imaging and optical communication are demonstrated. These results reveal the great prospects of 2D/3D integration in multifunctional optoelectronics, which may inspire novel 2D-related devices and expand their applications in widespread fields.

Cost analysis of next-generation imaging in high-risk prostate cancer staging

Introduction and objectiveNext-generation imaging (NGI) tests, such as choline PET/CT and PSMA PET, have shown to increase sensitivity in the detection of nodal and metastatic disease in prostate cancer. However, their use implies an increase in diagnostic costs compared to conventional imaging (CI) tests such as CT and bone scan. The aim of our study was to determine which diagnostic pathway is more cost-effective in high-risk prostate cancer. Material and methodCost-effectiveness analysis of the available imaging tests (CI, Choline/PSMA PET) for the staging of high-risk prostate cancer. Sensitivity and specificity were estimated based on published evidence, and costs were collected from the Management Department. In order to carry out a cost-effectiveness analysis, five diagnostic pathways were proposed estimating the accurate diagnoses. ResultsPSMA PET was the most accurate diagnostic option. The CI diagnostic workup was the most economical and CI+PSMA the most expensive. Analyzing the diagnostic cost-effectiveness ratio, CI+PSMA proved to be the most expensive (€5627.30 per correct diagnosis) followed by PET PSMA (€4987.11), choline (€4599.84) and CI (€4444.22). ConclusionsPSMA PET is the most accurate strategy in staging distant disease in patients with high-risk prostate cancer. Radiotracer uptake tests such as CI have been shown to be the most cost-effective option, followed by choline and PSMA.

Broadband Achromatic Imaging of a Metalens with Optoelectronic Computing Fusion.

The remarkable ultrathin ability of metalenses gives them potential as a next-generation imaging candidate. However, the inherent chromatic aberration of metalenses restricts their widespread application. We present an achromatic metalens with optoelectronic computing fusion (OCF) to mitigate the impact of chromatic aberration and simultaneously avoid the significant challenges of nanodesign, nanofabrication, and mass production of metalenses, a method different from previous methods. Leveraging the nonlinear fitting, we demonstrate that OCF can effectively learn the chromatic aberration mapping of metalens and thus restore the chromatic aberration. In terms of the peak signal-to-noise ratio index, there is a maximum improvement of 12 dB, and ∼8 ms is needed to correct the chromatic aberration. Furthermore, the edge extraction of images and super-resolution reconstruction that effectively enhances resolution by a factor of 4 are also demonstrated with OCF. These results offer the possibility of applications of metalenses in mobile cameras, virtual reality, etc.

Octofitter: Fast, Flexible, and Accurate Orbit Modeling to Detect Exoplanets

As next-generation imaging instruments and interferometers search for planets closer to their stars, they must contend with increasing orbital motion and longer integration times. These compounding effects make it difficult to detect faint planets but also present an opportunity. Increased orbital motion makes it possible to move the search for planets into the orbital domain, where direct images can be freely combined with the radial velocity and proper motion anomaly, even without a confirmed detection in any single epoch. In this paper, we present a fast and differentiable multimethod orbit-modeling and planet detection code called Octofitter. This code is designed to be highly modular and allows users to easily adjust priors, change parameterizations, and specify arbitrary function relations between the parameters of one or more planets. Octofitter further supplies tools for examining model outputs including prior and posterior predictive checks and simulation-based calibration. We demonstrate the capabilities of Octofitter on real and simulated data from different instruments and methods, including HD 91312, simulated JWST/NIRISS aperture masking interferometry observations, radial velocity curves, and grids of images from the Gemini Planet Imager. We show that Octofitter can reliably recover faint planets in long sequences of images with arbitrary orbital motion. This publicly available tool will enable the broad application of multiepoch and multimethod exoplanet detection, which could improve how future targeted ground- and space-based surveys are performed. Finally, its rapid convergence makes it a useful addition to the existing ecosystem of tools for modeling the orbits of directly imaged planets.

Application of next-generation imaging in biochemically recurrent prostate cancer.

Biochemical recurrence (BCR) following primary interventional treatment occurs in approximately one-third of patients with prostate cancer (PCa). Next-generation imaging (NGI) can identify local and metastatic recurrence with greater sensitivity than conventional imaging, potentially allowing for more effective interventions. This narrative review examines the current clinical evidence on the utility of NGI for patients with BCR. A search of PubMed was conducted to identify relevant publications on NGI applied to BCR. Given other relevant recent reviews on the topic, this review focused on papers published between January 2018 to May 2023. NGI technologies, including positron emission tomography (PET) radiotracers and multiparametric magnetic resonance imaging, have demonstrated increased sensitivity and selectivity for diagnosing BCR at prostate-specific antigen (PSA) concentrations <2.0 ng/ml. Detection rates range between 46% and 50%, with decreasing PSA levels for choline (1-3 ng/ml), fluciclovine (0.5-1 ng/ml), and prostate-specific membrane antigen (0.2-0.49 ng/ml) PET radiotracers. Expert working groups and European and US medical societies recommend NGI for patients with BCR. Available data support the improved detection performance and selectivity of NGI modalities versus conventional imaging techniques; however, limited clinical evidence exists demonstrating the application of NGI to treatment decision-making and its impact on patient outcomes. The emergence of NGI and displacement of conventional imaging may require a reexamination of the current definitions of BCR, altering our understanding of early recurrence. Redefining the BCR disease state by formalizing the role of NGI in patient management decisions will facilitate greater alignment across research efforts and better reflect the published literature.

Biochemical recurrence in patients with prostate cancer after primary definitive therapy: treatment based on risk stratification.

Nearly one-third of patients with prostate cancer (PCa) experience biochemical recurrence (BCR) after primary definitive treatment. BCR increases the risk of distant metastasis and mortality in patients with prognostically unfavorable features. These patients are best managed with a tailored treatment strategy incorporating risk stratification using clinicopathological factors, next-generation imaging, and genomic testing. This narrative review examines the utility of risk stratification for the management of patients with BCR in the context of clinical trial data, referencing the latest recommendations by European and US medical societies. PubMed was searched for relevant studies published through May 21 2023 on treatment of patients with BCR after radical prostatectomy (RP) or external beam radiotherapy (EBRT). European and US guidelines support the risk-stratified management of BCR. Post-RP, salvage EBRT (with or without androgen deprivation therapy [ADT]) is an accepted treatment option for patients with BCR. Post-EBRT, local salvage therapies (RP, cryotherapy, high-intensity focused ultrasound, stereotactic body radiotherapy, and low-dose-rate and high-dose-rate brachytherapy) have demonstrated comparable relapse-free survival rates but differing adverse event profiles, short and long term. Local salvage therapies should be used for local-only relapses while ADT should be considered for regional or distant relapses. In practice, patients often receive ADT, with varying guidance for intermittent ADT vs. continuous ADT, due to consideration of quality-of-life effects. Despite a lack of consensus for BCR treatment among guideline associations and medical societies, risk stratification of patients is essential for personalized treatment approaches, as it allows for an informed selection of therapeutic strategies and estimation of adverse events. In lower-risk disease, observation is recommended while in higher-risk disease, after failed repeat local therapy, ADT and/or clinical trial enrollment may be appropriate. Results from ongoing clinical studies of patients with BCR should provide consensus for management.