In October, we’re discussing advances in imaging that could dramatically improve how we treat prostate cancer. (Issue to be released to subscribers on Wednesday October 4.) In our Guest Commentary, Dr. Neal Shore does an excellent job summarizing these advances from a urological perspective, expanding on the interviews by Drs. Matthew Cooperberg and Raoul Concepcion. Dr. Michael Zelefsky discusses the impact these new imaging approaches, especially MRI, have in prostate cancer treatment planning.
Several common themes emerge. One is that the American healthcare system renders the best imaging technologies so expensive that rapid implementation at the community level is limited. The situation in Europe is markedly different; costs are 70-80% lower. As a result, Europe is leading both the development of better imaging technologies and the delivery of these technologies at a community level.
Another common theme is that advanced training and experience are required to use these imaging technologies well. Dr. Cooperberg does an excellent job of outlining this problem in prostate multiparameter MRI. The message for you is just because a nearby medical facility has purchased state-of-the-art imaging equipment does not mean they know how to use that equipment well. For now, travel to centers with a documented track record in using a new imaging technology.
Perhaps the most important point is that before a new imaging technology becomes standard treatment, extensive clinical trials need to validate the technique. How do you know when an imaging technique has passed such scrutiny? One landmark is whether or not the imaging technology has been FDA approved. For example, the C-11 Choline and Axumin imaging scans are FDA approved and covered by Medicare to detect metastatic prostate cancer. The Gallium-68 PSMA PET/CT scan is very promising, but not yet FDA approved.
In several of this month’s conversations, we mention the role of imaging in the management of oligometastatic disease. In oligometastatic disease treatment, we use radiation or surgery to eliminate metastases, potentially delaying cancer’s progression for a clinically useful time. By now, it is clear that there are patients who benefit from this treatment.
What is not clear is how effective we are at identifying who those patients are. This will only be resolved by well-designed randomized clinical trials. Fortunately, such trials are in progress and additional trials planned.
Charles E. Myers, Jr., MD