EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

Mottet, Nicolas; Bergh, Roderick C.N. van den; Briers, Erik; Broeck, Thomas Van den; Cumberbatch, Marcus; Santis, Maria De; Fanti, Stefano; Fossati, Nicola; Gandaglia, Giorgio; Gillessen, Silke; Grivas, Nikolaos; Grummet, Jeremy; Henry, Ann; Kwast, Theodorus H. van der; Lam, Thomas; Lardas, Michael; Liew, Matthew; Mason, Malcolm David; Moris, Lisa; Oprea-Lager, Daniela E.; Poel, Henk G. van der; Rouvière, Olivier; Schoots, Ivo G.; Tilki, Derya; Wiegel, Thomas; Willemse, Peter‐Paul M.; Cornford, Philip

doi:10.1016/j.eururo.2020.09.042

Cited by 1,717 publications

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“…The 99m Technetium BS is the most widely used imaging modality for the identification of PCa bone metastases, especially in the context of primary staging [ 4 ]. Sheikhbahaei et al [ 11 ] recently investigated the diagnostic accuracy of different modalities for the detection of bone metastases in PCa.…”

Section: Conventional Imaging In the Detection And Management Of Pmentioning

confidence: 99%

“…Abdominopelvic CT scan is largely used in staging PCa for the identification of lymph node involvement, mainly relying on morphology features (size, shape, and internal architecture) [ 15 ]. Lymph nodes are classified as malignant if the node is morphologically abnormal, regardless of nodal size, or when the short-axis exceeds a certain threshold, commonly 8 mm in the pelvis, or >10 mm outside the pelvis [ 4 , 16 ]. However, these thresholds are debated, and the size of non-metastatic lymph nodes varies widely, showing overlap with malignant lymph nodes, and vice-versa (with some malignant nodes being much smaller than the above thresholds) [ 4 , 15 , 16 , 17 ].…”

Section: Conventional Imaging In the Detection And Management Of Pmentioning

confidence: 99%

“…In routine practice, initial clinical suspicion of PCa is usually triggered by an elevated prostate-specific antigen (PSA) and/or an abnormal digital rectal examination (DRE). For a definitive diagnosis, histopathological confirmation is required, and typically obtained by transrectal ultrasound (TRUS) guided needle biopsies [ 4 ]. PCa has been classified into five prognostically distinct Grade Groups (GGs) by the International Society of Urological Pathology (ISUP), based on the Gleason Score (GS) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Accurate staging of PCa, both at initial diagnosis and at biochemical recurrence (BCR) after previous curative-intent therapy, is important to determine prognosis, and for selecting the optimal treatment strategy. According to the current EAU guidelines, metastatic screening by means of “at least” an abdominopelvic computed tomography (CT)-scan and bone scintigraphy (BS) ( 99m Tc-phosphonate), is recommended in patients with intermediate or high-risk PCa to evaluate the extent of extra-prostatic disease [ 4 ]. However, these conventional imaging modalities have limited sensitivity and specificity, affecting their ability to accurately quantify the true extent of disease, especially at low PSA-levels or in the setting of limited volume, oligometastatic disease.…”

Section: Introductionmentioning

confidence: 99%

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Nuclear Imaging for Bone Metastases in Prostate Cancer: The Emergence of Modern Techniques Using Novel Radiotracers

Luining

Meijer

Dahele³

et al. 2021

Diagnostics

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Accurate staging of prostate cancer (PCa) at initial diagnosis and at biochemical recurrence is important to determine prognosis and the optimal treatment strategy. To date, treatment of metastatic PCa has mostly been based on the results of conventional imaging with abdominopelvic computed tomography (CT) and bone scintigraphy. However, these investigations have limited sensitivity and specificity which impairs their ability to accurately identify and quantify the true extent of active disease. Modern imaging modalities, such as those based on the detection of radioactively labeled tracers with combined positron emission tomography/computed tomography (PET/CT) scanning have been developed specifically for the detection of PCa. Novel radiotracers include 18F-sodium fluoride (NaF), 11C-/18F-fluorocholine (FCH), 18F-fluordihydrotestosterone (FDHT), 68Gallium and 18F-radiolabeled prostate-specific membrane antigen (e.g., 68Ga-PSMA-11, 18F-DCFPyL). PET/CT with these tracers outperforms conventional imaging. As a result of this, although their impact on outcome needs to be better defined in appropriate clinical trials, techniques like prostate-specific membrane antigen (PSMA) PET/CT have been rapidly adopted into clinical practice for (re)staging PCa. This review focuses on nuclear imaging for PCa bone metastases, summarizing the literature on conventional imaging (focusing on CT and bone scintigraphy—magnetic resonance imaging is not addressed in this review), highlighting the prognostic importance of high and low volume metastatic disease which serves as a driver for the development of better imaging techniques, and finally discussing modern nuclear imaging with novel radiotracers.

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Section: Conventional Imaging In the Detection And Management Of Pmentioning

confidence: 99%

Section: Conventional Imaging In the Detection And Management Of Pmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nuclear Imaging for Bone Metastases in Prostate Cancer: The Emergence of Modern Techniques Using Novel Radiotracers

Luining

Meijer

Dahele³

et al. 2021

Diagnostics

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“…The European Association of Urology, in some instances, together with other international associations, such as the European Association of Nuclear Medicine, European Society for Radiotherapy and Oncology, European Society of Urogenital Radiology, and International Society of Geriatric Oncology, has recently updated the guidelines for the management of kidney [ 5 ], prostate [ 6 , 7 ], and bladder [ 8 ] tumors. On the other hand, pathological updates in tumor staging [ 9 ] and grading [ 10 ] of genitourinary tumors also appeared in 2020.…”

mentioning

confidence: 99%

Insights into Urological Cancer

Manini

López

2021

Cancers

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A Pragmatic Approach to Prostate Cancer Screening

Tosoian,

Penson,

Chinnaiyan

2024

JAMA

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The introduction of prostate-specific antigen (PSA)-based screening for prostate cancer in the early 1990s was followed by a nearly 2-decade long decline in prostate cancer metastasis and mortality. 1 However, clinical trial data revealed that screening was associated with substantial harms. 2 Under the traditional clinical approach in which elevated serum PSA triggered prostate biopsy, roughly 1 in 5 screened men underwent biopsies, with more than 75% found to be negative and a majority of positive biopsies harboring low-grade, clinically insignificant cancers. 3 Prostate biopsies are uncomfortable for patients and carry a risk of bleeding and infection requiring hospitalization. 4 Moreover, during a previous era in which a cancer diagnosis was inexorably linked to treatment, overdiagnosis (ie, detection of indolent cancers that would not have been detected during life in the absence of screening) and overtreatment resulted in significantly reduced quality of life. 5 In 2012, the US Preventive Services Task Force (USPSTF) provided a grade D recommendation against the use of PSA screening, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms. 6 In the time since, longer-term outcomes from highquality studies have better informed the benefits of screening. After 22 years of follow-up in the Gotebörg screening trial, 7 the rate ratio for prostate cancer death in screening participants was 0.59 (95% CI, 0.43-0.80), with a number needed to invite to screening of 221 and number needed to treat of 9 to prevent 1 death from prostate cancer-figures that compare favorably with other common cancers. 8,9 At the same time, a growing understanding of prostate cancer has led to advances to reduce the harms previously associated with screening. For men with favorable-risk cancers, adoption of active surveillance-a management strategy centered on monitoring rather than immediate treatment-has reduced overtreatment and its associated adverse effects. 10 In large part due to these studies quantifying benefit and development of approaches to minimize harms, in 2018 the USPSTF offered an updated grade C recommendation for PSA screening, recommending individualized decision-making in men aged 55-69 years. 11 Current clinical guidelines emphasize a narrowed diagnostic focus on identifying higher-grade cancers, recommending that patients with an elevated PSA level undergo magnetic resonance imaging (MRI), if available, or biomarker testing to better define the risk of high-grade (grade group [GG] ≥2) disease prior to biopsy. 12-14 Indeed, MRI with targeted biopsy improves detection of high-grade cancers relative to stan-Multimedia

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EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

Cited by 1,717 publications

References 184 publications

Nuclear Imaging for Bone Metastases in Prostate Cancer: The Emergence of Modern Techniques Using Novel Radiotracers

Nuclear Imaging for Bone Metastases in Prostate Cancer: The Emergence of Modern Techniques Using Novel Radiotracers

Insights into Urological Cancer

A Pragmatic Approach to Prostate Cancer Screening

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