Dr. Einstein on Novel Imaging Tools in Prostate Cancer

David J. Einstein, MD, genitourinary medical oncologist, Beth Israel Deaconess Medical Center, discusses novel imaging tools used in prostate cancer.

Many investigators have developed various imaging strategies to improve upon the sensitivity of available modalities, says Einstein. These approaches range from choline C-11 PET scan, to the 18F sodium fluoride PET/CT scan, to the newly FDA-approved fluciclovine PET/CT scan, to prostate-specific membrane antigen scans. Many of these technologies are various PET modalities that differ from conventional PET scans. The goal of these modalities is to pick up disease at lower levels than what was previously possible with traditional methods. Whether that helps patients has yet to be determined, says Einstein.

However, being able to detect small amounts of disease may help guide a patient’s intended course of treatment. For example, if postoperative patients are scheduled to receive salvage radiation to the prostate area, physicians may opt for sensitive imaging to guide that beam rather than radiating blindly, explains Einstein.

Another potential application for these modalities could be in patients who have already been through all of the standard local therapies, have rising prostate-specific antigen, and don't have anything on a conventional scan. Whether oligometastatic recurrences can be identified early and receive metastasis-directed therapy remains of debate. However, data from the phase II STOMP trial seemed to suggest a delayed time to ADT when metastasis-directed therapy was employed.