5
Metastatic CRPC
PSA progression
➤ Recommendation 4.9. PSA progression alone for men on treatment
for metastatic CRPC should not be the sole reason to change
therapy. Conventional imaging can be utilized for initial evaluation
of PSA progression and should be continued to facilitate changes/
comparisons and serially to assess for development of radiographic
progression. (Strong Recommendation; IC-U-I).
➤ Recommendation 4.10. The use of NGI in this cohort is unclear,
with a paucity of prospective data. When a change in clinical
care is contemplated, in an individualized manner, and there is a
high clinical suspicion of subclinical metastasis despite negative
conventional imaging, the use of NGI could be contemplated,
especially in the setting of a clinical trial (Weak Recommendation;
IC-U-Ins).
Radiographic progression on conventional imaging
➤ Recommendation 4.11. In men with metastatic CRPC with clear
evidence of radiographic progression on conventional imaging
while on systemic therapy, NGI should not be routinely offered.
NGI may play a role if performed at baseline to facilitate
comparison of imaging findings/extent of progression of disease
(Moderate Recommendation; IC-U-Ins).
Abbreviations
BS, bone scintigraphy; CRPC, castration-resistant prostate cancer; CT, computerized
tomography; Mets, metastatic disease; mpMRI, multiparametric magnetic resonance
imaging ; MRI, magnetic resonance imaging ; NCCN, National Comprehensive Cancer
Network; NGI; next generation imaging ; PET, positron emission tomography; PSA,
prostate specific antigen; PSMA, prostate specific membrane antigen; WB, whole body
