Detection and localization of recurrent prostate cancer is critical for optimal patient management1

1 in 3 men treated for primary prostate cancer experiences a biochemical recurrence1

Up to one-third of men treated for primary prostate cancer will experience a biochemical recurrence (BCR) within 10 years.1 One-third of those men will develop metastatic disease within 8 years.1

Men treated for primary prostate cancer

1 in 3 men treated for primary prostate cancer experiences biochemical recurrence.

Limitations of current imaging procedures:

The most commonly used imaging procedures:

  • Have low detection rates: Positive findings occur in only ~11% of patients with biochemical recurrence.2 
  • May not detect small tumors: Some imaging procedures may be unable to detect recurrent prostate tumors <1 cm in size or when PSA levels are <10 ng/mL—when cancer may be more effectively managed or treated with localized therapy.3-8 
  • Difficult for everyday use: Some imaging procedures can be time consuming, or present challenges for reproducibility of results.9-11
  • May require multiple scans to evaluate all potential metastatic sites: Bone scans, CT, and/or MRI may be necessary.3
Inconclusive CT scan: Axial View. Without Axumin

Inconclusive CT imaging: Axial view. Post radical prostatectomy and negative lymphadenectomy with PSA elevated to 0.73 ng/mL. MR and earlier skeletal screening were negative for malignancy.

There is a clinical need for new tools, such as imaging agents, to better assess the location and extent of recurrent disease.12-15

References

  1. Bruce JY, Lang JM, McNeel DG, Liu G. Current controversies in the management of biochemical failure in prostate cancer. Clin Adv Hematol Oncol. 2012;10(11):716-722.
  2. Choueiri TK, Dreicer R, Paciorek A, Carroll PR, Konety B. A model that predicts the probability of positive imaging in prostate cancer cases with biochemical failure after initial definitive local therapy. J Urol. 2008;179(3):906-910.
  3. Hricack H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging prostate cancer: a multidisciplinary perspective. Radiology. 2007;243(1):28-53.
  4. Kirkham AP, Emberton M, Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol. 2006;50(6):1163-1174.
  5. Schiavina R, Ceci F, Borghesi M, et al. The dilemma of localizing disease relapse after radical treatment for prostate cancer: which is the value of the actual imaging techniques? Curr Radiopharm. 2013;6(2):92-95.
  6. Wolf JS Jr, Cher M, Dall’era M, Presti JS Jr, Hricak H, Carroll PR. The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol. 1995;153(3 Pt 2):993-999.
  7. Merdan S, Womble PR, Miller DC, et al. Toward better use of bone scans among men with early-stage prostate cancer. Urology. 2014;84(4):793-798.
  8. Ikonen S, Kärkkäinen P, Kivisaari L, et al. Magnetic resonance imaging of clinically localized prostatic cancer. J Urol. 1998;159(3):915-919.
  9. Hegde JV, Mulkern RV, Panych LP, et al. Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging. 2013;37(5):1035-1054.
  10. Aparici CM, Carlson D, Nguyen N, Hawkins RA, Seo Y. Combined SPECT and multidetector CT for prostate cancer evaluations. Am J Nucl Med Mol Imaging. 2012;2(1):48-54.
  11. Taneja SS. Imaging in the diagnosis and management of prostate cancer. Rev Urol. 2004;6(3):101-113.
  12. Paller CJ, Antonarakis ES. Management of biochemically recurrent prostate cancer after local therapy: evolving standards of care and new directions. Clin Adv Hematol Oncol. 2013;11(1):14-23.
  13. Darwish OM, Raj GV. Management of biochemical recurrence after primary localized therapy for prostate cancer. Front Oncol. 2012;2:48.
  14. Agarwal PK, Sadetsky N, Konety BR, Resnick MI, Carroll PR; Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE). Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer. 2008;112(2):307-314.
  15. Hershman DL, Unger JM, Wright JD, et al. Adverse health events following intermittent and continuous androgen deprivation in patients with metastatic prostate cancer. JAMA Oncol. 2016;2(4):453-461.