The use of nuclear medicine has expanded rapidly in recent years, largely thanks to the emergence of new imaging technologies, such as positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT), which have improved the accuracy of detection, localization and characterization of disease. Advances in radiochemistry have also enabled the production of novel radiotracers. These advances have made nuclear medicine one of the most vibrant and dynamic specialities in medicine today.
The European Association of Nuclear Medicine (EANM), the society for nuclear medicine, molecular imaging and theranostics, is to hold its first Focus Meeting in February to supplement its Annual Congress in October. The international conference on Molecular Imaging and Theranostics in Prostate Cancer will be held on February 1–3 February 2018 in Valencia, Spain, and will involve a multidisciplinary group of experts and opinion leaders from around the world. According to the meeting Chair, Wim Oyen, prostate cancer was chosen as the subject of the first focus meeting because it is a rapidly developing field, with many new therapeutic options becoming available to patients. In terms of nuclear medicine, new therapeutics such as radium-223 have become available, but also new imaging modalities that are targeting metastatic prostate cancer very efficiently and helping identify disease location and activity.
Despite many recent advances, prostate cancer remains a major health and economic burden worldwide.1 While nuclear medicine and new imaging techniques have made a major contribution to the diagnosis and treatment of this disease, there still remain many challenges and opportunities. The EANM FOCUS programme will feature five topics that highlight these challenges. The first, staging of high risk prostate cancer, will discuss the contribution of radiology and nuclear medicine, and debate whether there is still a need for CT and bone scanning. Most experts agree that bone scans have limited sensitivity for disease detection and lack both specificity and sensitivity for assessing treatment response. The development of SPECT combined with CT has improved detection sensitivity and specificity, but has not yet resulted in improvements in monitoring therapy. A number of promising bone-specific and tumour-specific tracers for PET/CT have emerged for advanced prostate cancer that show promise in both clinical settings. In addition, whole-body magnetic resonance imaging (WB-MRI) incorporating diffusion-weighted imaging offers improved detection and assessment of treatment response.2
The second session discusses imaging of biochemical recurrence of prostate cancer and addresses an important unmet medical need. An increase in the prostate-specific antigen level after radical prostatectomy may indicate local relapse, distant relapse or both. It is essential to differentiate between these two patterns of relapse to select the appropriate treatment strategy. Choline PET/CT and the new tracer gallium-68 prostate-specific membrane antigen (PSMA)-PET imaging appear useful in discriminating patients with local, lymph node and bone recurrences.3,4 This session will also feature a debate on whether biochemical recurrence should be addressed as soon as possible.
Radiology and nuclear medicine have also made important contributions to the imaging of advanced prostate cancer, which is the subject of the third session. The introduction of these new imaging techniques have enabled the diagnosis of a previously unknown disease, oligometastatic prostate cancer after local therapy, an intermediate metastatic state where the number and site of metastatic tumours are limited and which may present an opportunity for targeted local therapy rather than hormone therapy.5,6 This session’s controversy to be debated is: do we need modern imaging for oligometastatic prostate cancer?
Session four addresses the therapy of metastatic castrate resistant prostate cancer (mCRPC), including radium-223, whose relatively good toxicity profile makes it an attractive option for patients with only bone metastases and who are unfit for docetaxel.7 The session will also discuss the emerging therapeutic option of PSMA radioligands for mCRPC,8 as well as debating whether targeted systemic radiotherapy should become clinical practice.
The final session explores new prostate cancer targets for imaging and therapy. This includes the discovery of new pathways that may yield future therapeutic targets. Furthermore, understanding of the role of prostate cancer genetics has increased dramatically in the last 10 years following the development of the genome wide association study (GWAS).9 The session also considers the latest radiopharmaceutical developments and considers the disease from the perspective of a pathologist, a patient and the foundation.
A large faculty of oncologists, urologists, imagers, clinical and basic scientists and patient advocates will participate in these discussions, providing an overview of the current state-of-the-art and future directions in the role of imaging in general and nuclear medicine in prostate cancer. Meeting co-chair, Stefano Fanti, stated that the objectives of the meeting are to address the progress on nuclear medicine and the relevance of imaging techniques and hopefully to produce a consensus statement that will be shared between the many professionals working in the field.
Support: Katrina Mountfort is a freelance medical writer working on behalf of Touch Medical Media.
References
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3. Mapelli P, Incerti E, Ceci F, et al. 11C- or 18F-choline PET/CT for imaging evaluation of biochemical recurrence of prostate cancer. J Nucl Med. 2016;57:43S–8S.
4. Grubmuller B, Baltzer P, D’Andrea D, et al. (68)Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy – diagnostic performance and impact on therapeutic decision-making. Eur J Nucl Med Mol Imaging. 2018;45:235–42.
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9. Benafif S, Kote-Jarai Z, Eeles RA. A review of prostate cancer genome wide association studies (GWAS). Cancer Epidemiol Biomarkers Prev. 2018; doi: 10.1158/1055-9965.EPI-16-1046. [Epub ahead of print].
