Latest updates on molecular imaging and theranostics

[GaryG1950]

Consensus on molecular imaging and theranostics in prostate cancer.

December 25, 2018

"Rapid developments in imaging and treatment with radiopharmaceuticals targeting prostate cancer pose issues for the development of guidelines for their appropriate use. To tackle this problem, international experts representing medical oncologists, urologists, radiation oncologists, radiologists, and nuclear medicine specialists convened at the European Association of Nuclear Medicine Focus 1 meeting to deliver a balanced perspective on available data and clinical experience of imaging in prostate cancer, which had been supported by a systematic review of the literature and a modified Delphi process. Relevant conclusions included the following: diphosphonate bone scanning and contrast-enhanced CT are mentioned but rarely recommended for most patients in clinical guidelines; MRI (whole-body or multiparametric) and prostate cancer-targeted PET are frequently suggested, but the specific contexts in which these methods affect practice are not established; sodium fluoride-18 for PET-CT bone scanning is not widely advocated, whereas gallium-68 or fluorine-18 prostate-specific membrane antigen gain acceptance; and, palliative treatment with bone targeting radiopharmaceuticals (rhenium-186, samarium-153, or strontium-89) have largely been replaced by radium-223 on the basis of the survival benefit that was reported in prospective trials, and by other systemic therapies with proven survival benefits. Although the advances in MRI and PET-CT have improved the accuracy of imaging, the effects of these new methods on clinical outcomes remains to be established. Improved communication between imagers and clinicians and more multidisciplinary input in clinical trial design are essential to encourage imaging insights into clinical decision making."

The Lancet. Oncology. 2018 Dec [Epub]

[NPfisherman]

When my PSA went past 2, I had to undergo a bone scan and a CT scan of abdomen/ pelvis--they revealed NOTHING....only with the auxumin scan did they find the lesion on my clavicle...that was end of October, I had Lupron shot and started Zytiga in early November....and just finished having stereotactic radiation to zap the lesion completed Dec 24.... My point on this, from my story is .... lytic lesions don't show up frequently on bone scans ....CT scans may not show the whole story of the disease... better imaging helped me begin treating my cancer.....years ago, you had to wait for your disease to be more advanced to find it....better scans are part of the answer...it is another thing to be thankful for that I forgot on my prior post....

[NPfisherman]

Good find...I believe the added cost of these scans to the insurance companies will play a role in usage....after all, the CEO at the insurance company must make his/her bonus...