Novel Imaging Slated to Change Trajectory of Prostate Cancer Treatment
Novel Imaging Slated to Change Trajectory of Prostate Cancer Treatment: Hussein Aoun, MD, discusses the use of novel imaging modalities and contrasted them with conventional imaging tools in prostate cancer.
Hussein Aoun, MD
Novel next-generation imaging modalities have greater visibility than
conventional imaging tools, leading to higher detection rates and
earlier treatment of early recurrences and metastatic disease among men
with prostate cancer, explained Hussein Aoun, MD.
“With MRI, we can identify clinically significant lesions and stage
local disease to see if there is extraprostatic extension. In terms of
metastatic or early recurrent disease, we have PET scans with agents
such as 18F-fluciclovine (Axumin), where we can identify lesions earlier
that we would not have seen previously with a CT scan or conventional
bone scan,” said Aoun.
In an interview during the 2019 OncLive ® State of
the Science Summit™ on Genitourinary Cancers, Aoun, a radiologist at
Barbara Ann Karmanos Cancer Institute, discussed the use of novel
imaging modalities and contrasted them with conventional imaging tools
in prostate cancer.
OncLive: What imaging modalities are currently being used in prostate cancer?
Aoun: For local staging, you can use MRI or ultrasound.
Ultrasound is primarily used to guide a biopsy. MRI is used more for
local staging and identifying suspicious lesions. [MRI] can have a
significant impact on the patient's care. When we talk about metastatic
disease, the PET scan has become a big player in the field, and new
agents have helped us identify early recurrences.
How do next-generation imaging modalities compare with conventional modalities?
Before, we only had ultrasound for local imaging and staging. The
sensitivity and specificity of ultrasound was pretty low in detecting
prostate cancer, unless patients had a [full-blown] nodule. Now, we have
MRI, which has a very high resolution.
How do the next-generation imaging tools compare with one another?
18F-fluciclovine has become a player in evaluating early recurrence. It
was compared with choline C-11, and fluciclovine was shown to be of more
benefit in identifying recurrent disease.
How do you see the role of conventional imaging evolving?
We are moving in a direction in which imaging will help us assess
patients in a way that improves outcomes. We will detect and treat
disease earlier. Also, we will stage patients who are on active
surveillance, whereby we could potentially detect their cancers
earlier.
Where should future research focus?
Research should focus on targeting metastatic disease with molecular imaging.
What is your take-home message to your colleagues regarding novel imaging tools in prostate cancer?
There are multiple cases where imaging has made a difference in the
patient's management, whether they had previous negative biopsies that
were detected with MRI, or whether for patients were upstaged on active
surveillance. Additionally, in patients who had previous treatment in
whom we were looking for local recurrence. On the other hand, in some
patients with metastatic disease, there can be equivocal scans with a CT
scan or bone scan. When we use a PET scan with 18F-fluciclovine, we
identified local disease that was able to be targeted.
Hussein Aoun, MD
conventional imaging tools, leading to higher detection rates and
earlier treatment of early recurrences and metastatic disease among men
with prostate cancer, explained Hussein Aoun, MD.
“With MRI, we can identify clinically significant lesions and stage
local disease to see if there is extraprostatic extension. In terms of
metastatic or early recurrent disease, we have PET scans with agents
such as 18F-fluciclovine (Axumin), where we can identify lesions earlier
that we would not have seen previously with a CT scan or conventional
bone scan,” said Aoun.
In an interview during the 2019 OncLive ® State of
the Science Summit™ on Genitourinary Cancers, Aoun, a radiologist at
Barbara Ann Karmanos Cancer Institute, discussed the use of novel
imaging modalities and contrasted them with conventional imaging tools
in prostate cancer.
OncLive: What imaging modalities are currently being used in prostate cancer?
Aoun: For local staging, you can use MRI or ultrasound.
Ultrasound is primarily used to guide a biopsy. MRI is used more for
local staging and identifying suspicious lesions. [MRI] can have a
significant impact on the patient's care. When we talk about metastatic
disease, the PET scan has become a big player in the field, and new
agents have helped us identify early recurrences.
How do next-generation imaging modalities compare with conventional modalities?
Before, we only had ultrasound for local imaging and staging. The
sensitivity and specificity of ultrasound was pretty low in detecting
prostate cancer, unless patients had a [full-blown] nodule. Now, we have
MRI, which has a very high resolution.
How do the next-generation imaging tools compare with one another?
18F-fluciclovine has become a player in evaluating early recurrence. It
was compared with choline C-11, and fluciclovine was shown to be of more
benefit in identifying recurrent disease.
How do you see the role of conventional imaging evolving?
We are moving in a direction in which imaging will help us assess
patients in a way that improves outcomes. We will detect and treat
disease earlier. Also, we will stage patients who are on active
surveillance, whereby we could potentially detect their cancers
earlier.
Where should future research focus?
Research should focus on targeting metastatic disease with molecular imaging.
What is your take-home message to your colleagues regarding novel imaging tools in prostate cancer?
There are multiple cases where imaging has made a difference in the
patient's management, whether they had previous negative biopsies that
were detected with MRI, or whether for patients were upstaged on active
surveillance. Additionally, in patients who had previous treatment in
whom we were looking for local recurrence. On the other hand, in some
patients with metastatic disease, there can be equivocal scans with a CT
scan or bone scan. When we use a PET scan with 18F-fluciclovine, we
identified local disease that was able to be targeted.
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