Imaging Studies in Metastatic Urogenital Cancer Patients Undergoing Systemic Therapy: Recommendations of a Multidisciplinary Consensus Meeting of the Association of Urological Oncology of the German Cancer Society

Abstract

Introduction: Imaging studies are an integral and important diagnostic modality to stage, to monitor and follow-up patients with metastatic urogenital cancer. The currently available guidelines on diagnosis and treatment of urogenital cancer do not provide the clinician with evidence-based recommendations for daily practice. Objectives: To develop scientifically valid recommendations with regard to the most appropriate imaging technique and the most useful time interval in metastatic urogenital cancer patients undergoing systemic therapy. Methods: A systematic literature review was performed searching MedLine, Embase and Web of Science databases using the terms prostate, renal cell, bladder and testis cancer in combination with the variables lymph node, lung, liver, bone metastases, chemotherapy and molecular therapy, and the search terms computed tomography, magnetic resonance imaging and positron emission tomography were applied. A total of 11,834 records were retrieved from all databases. The panel reviewed the records to identify articles with the highest level of evidence using the recommendation of the US Agency for Health Care Policy and Research. Conclusions: Contrast-enhanced computed tomography remains the standard imaging technique for monitoring of pulmonary, hepatic and lymph node metastases. Bone scintigraphy is still the most widely used imaging technique for the detection and follow-up of osseous lesions. For clinical trials it might be replaced by either PET-CT or MRI of the skeletal axis. Response assessment for patients treated with cytotoxic regime is best performed by the RECIST/WHO criteria; treatment response to molecular triggered therapy is best assessed by CT evaluating decrease in tumor size and density. Cross-sectional imaging studies for response assessment might be obtained after each 2 cycles of systemic therapy to early stratify responders from non-responders.

Serum Levels of MicroRNA371a-3p: A Highly Sensitive Tool for Diagnosing and Staging Testicular Germ Cell Tumours: A Clinical Case Series

“…Traditional clinical examination is the least sensitive method because it is highly dependent on personal experience. Medical imaging, for example, CT and MRI can accurately document metastases larger than 1 cm in diameter but significantly lack sensitivity in diagnosing small secondaries [2,3] . Moreover, the specificity of medical imaging is unfavourable, too, because 10-20% false-positive results may occur [4,5] .…”

Management of Bone Metastases in Patients with Castration-Resistant Prostate Cancer

“…For the detection of osseous lesions conventional radiography, computed tomography (CT), nuclear imaging and magnetic resonance imaging (MRI) are the four principal modalities used in the clinic [25,26] (table 1). Most international guidelines still consider technetium-99 ( 99m Tc) bone scintigraphy and plain X-ray radiography as the mainstay of imaging methods to detect and follow bone metastases [27,28].…”

Volumetric assessment of lymph node metastases in patients with non-seminomatous germ cell tumors treated with chemotherapy

“…Imaging plays a major role in the initial diagnosis, but it is also an integral part for response assessment and follow-up after systemic therapy. 5,6 Abdominopelvic computed tomography (CT) scan is the standard method for analyzing response to treatment. A CT scan offers a sensitivity of 70% to 80% in determining the state of the retroperitoneal nodes; 6 a CT scan uses a 3-mm threshold to define metastatic nodes in the lymphatic landing zones.…”

“…5,6 Abdominopelvic computed tomography (CT) scan is the standard method for analyzing response to treatment. A CT scan offers a sensitivity of 70% to 80% in determining the state of the retroperitoneal nodes; 6 a CT scan uses a 3-mm threshold to define metastatic nodes in the lymphatic landing zones. In clinical stages I and II, the understaging rate is 25% to 30%.…”

“…Residual masses should be measured as a therapeutic response to select ideal candidates for further treatment or surveillance. 8 Response has been assessed using the RECIST criteria (Response Evaluation Criteria in Solid Tumours) in clinical trials, 6 whereas the World Health Organization (WHO) criteria 5 are used in daily practice. Volumetric analysis of lymph nodes may be a promising measurement method and has been successfully introduced for lung and liver lesions.…”