New imaging technologies and management of CRPC

An article in the June issue of the journal Acta Oncologia discusses the potential of  newer types of imaging technology as methods to monitor the progression of disease in men with castrate-resistant prostate cancer (CRPC).

In this article, Fox et al. specifically address the increasing number of new therapies now available or in development for the treatment of CRPC, many of which are directed against the androgen-receptor (AR) signaling axis, and the consequent need for reliable molecular imaging technologies that can help us to determine the effectiveness of these new therapies and the appropriate selection of agents to treat individual patients.

The article focuses on three newer types of imaging technology:

  • Bone scintigraphy
  • 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)
  • Positron emission tomography (PET) imaging of the AR signaling axis.

Rigorous standardization and structured validation of any new test must be carried out before  any assay or imaging technology can be used successfully and consistently in appropriate clinical context.

The Prostate Cancer Working Group 2 (PCWG2) has developed and started to apply a series of criteria which they hope to use to define “radiographic” progression by bone scintigraphy serve as a paradigm of this process.

Na18F-PET is said to be superior to single-photon bone scanning, but its value for imaging of bone metastases is not yet established. FDG-PET has already demonstrated its clinical value in management of many diseases, but we need more compelling data before we can establish its value in the management of CRPC.

PET tracers that can be used to probe the AR signaling axis, e.g, 18F-FDHT and 89Zr-591, are in development as potential markers of efficacy, in tandem with FDG-PET.

While it is going to take time to establish the real value of these new imaging technologies as methods to accelerate new drug development and to monitor the progression of disease in men with CRPC, it is to be hoped that in the not too distant future we will be able to apply technologies like this to the improvement of care and outcomes in the treatment of many patients with advanced forms of prostate cancer.

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