Patient Profile 3: High-Risk Prostate Cancer
Steven Finkelstein, MD, DABR, FACRO, presents a high-risk prostate cancer patient profile for a 74-year-old man with a history of chronic prostatitis.
EP: 1.Rapid Advances in Prostate Cancer Imaging
EP: 2.PSMA PET Scans for Prostate Cancer Imaging
EP: 3.PSMA PET Clinical Trials
EP: 4.The Multidisciplinary Approach to Prostate Cancer Management
EP: 5.The Learning Curve of PSMA PET Scans
EP: 6.Patient Profile 1: High-Risk Localized Prostate Cancer
EP: 7.Prostate Cancer Imaging: the OSPREY Trial
EP: 8.Key Messages from the OSPREY Trial
EP: 9.Visual Analysis vs SUV for Prostate Cancer Imaging
EP: 10.Discussing Treatments with Patients Based on Prostate Cancer Imaging
EP: 11.The Role for PSMA PET Imaging in Prostate Cancer Monitoring
EP: 12.Patient Profile 2: High-Risk Prostate Cancer
EP: 13.Patient Profile 3: High-Risk Prostate Cancer
EP: 14.Bone Scans for Prostate Cancer Imaging
EP: 15.Patient Profile 4: Recurrent Prostate Cancer
EP: 16.Prostate Cancer Imaging: the CONDOR Trial
EP: 17.Patient Profile 5: IMRT for Adenocarcinoma
EP: 18.Patient Profile 6: Robotic Radical Prostatectomy for Adenocarcinoma
EP: 19.Patient Profile 7: Gleason 7 Prostate Cancer
EP: 20.Prostate Cancer Imaging: the VISION Trial
EP: 21.The Future of Prostate Cancer Imaging
Neal Shore, MD, FACS: Let’s stick with the theme of high-risk prostate cancer. And Steven, this is your case.
Steven Finkelstein, MD, DABR, FACRO: This is a patient with high-risk prostate cancer. It’s a 74-year-old gentleman with a history of chronic prostatitis. His PSA [prostate-specific antigen] was 6.5 ng/ml, and a biopsy was done, and it showed prostate adenocarcinoma Gleason score of 8 with perineural invasion. An MRI was done and showed a 0.9 cm lesion, a technetium-99m bone scan was done, and that showed a focal radiotracer in the lateral left 9th rib. It’s important for the audience that when you see things on bone scan, it should also correlate that with a clinical question, which is, did you ever fall? Did you ever break something? Do you ever have an issue? He had a CT [scan], which showed a nonaggressive appearing reticular density in the left 9th rib. Most compatible with a benign fibro-osseous lesion, which he happened to be told about years before. Now, what are you going to do for this guy? Would you also order a PSMA [prostate-specific membrane antigen] PET [positron emission tomography]?
Neal Shore, MD, FACS: Mike, what would you do here? I’m thinking yes, but I’ll defer to your experience.
Michael Gorin, MD: I would’ve started with the PSMA PET and foregone the technetium-99m bone scan and the CT because in the NCCN [National Cancer Comprehensive Network] guidelines it now states that you do not require conventional imaging prior to triggering ordering a PSMA PET scan. For me, high-risk disease equals reflexive PSMA-PET scan. But in this case, given what we know, certainly, I would order a PSMA-PET scan in this context as well.
Lawrence Saperstein, MD: It brings up a great point of educating the community who’s going to be ordering these scans because it looks like we’re falling back into the conventional workup of a CT and a bone scan in this patient. And we can look at the pictures and see what we see.
Neal Shore, MD, FACS: But that’s an important point. Take-home message. And now that the guidelines are saying that you do not have to get conventional CT scan and technician bone scan prior to getting a PSMA PET, I think we all agree with that.
Transcript edited for clarity.
Phase 1B trial to evaluate relugolix and enzalutamide in high-risk prostate cancer
July 24th 2024"Going forward after this study, we hope to be able to expand and potentially look at patients undergoing either surgery or radiation therapy, and really try to determine the potential benefit," says Kelly L. Stratton, MD, FACS.
