Synthesizing and Applying Molecular Targeted Imaging Results in Patients With Prostate Cancer (RADAR VII)

Abstract

Purpose: Molecular targeted imaging (MTI) is one of the most powerful new tools in the prostate cancer arsenal, but incorporation of MTI results into treatment decision making continues to be a challenge. Guidance is available for clinicians to determine when and how frequently MTI should be used, but clinicians also need to know how MTI results should influence management decisions. Materials and methods: In this review, the Radiographic Assessments for Detection of Advanced Recurrence (RADAR) VII group has developed consensus guidance for the use of MTI in clinical decision making. RADAR VII sought to include all physicians involved in the management of prostate cancer, including urologists, medical oncologists, radiation oncologists, and nuclear medicine specialists. Results: Recommendations were developed for the management of localized, biochemically recurrent, or nonmetastatic castrate-resistant prostate cancer (nmCRPC) by conventional imaging and metastatic disease by MTI. Recommendations were also developed for the treatment of patients with equivocal MTI results. These recommendations are based largely on clinical experience and limited clinical data because of a lack of high-quality, prospective studies regarding the role of MTI in clinical decision making. As such, the RADAR VII group also provides a framework for the incorporation of MTI into ongoing and future clinical trials to support the development of more robust recommendations. Conclusions: We developed several recommendations for the interpretation and application of MTI results for patients with localized disease, biochemical recurrence, and nmCRPC on conventional imaging. These recommendations should be viewed within the context of the limited available evidence and the dynamic nature of prostate cancer research.