Management of nmCRPC: Imaging Test Frequency & Biochemical Follow-Up
This project's focus is on the discussion surrounding the monitoring of imaging tests in non-metastatic castration-resistant prostate cancer (nmCRPC) patients. Insights from experts suggest a balance between annual imaging tests and relying on biochemical follow-up. The case details of a 72-year-old patient are used to emphasize the importance of PSA monitoring and the choice of imaging based on PSA progression.
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Presentation Transcript
Project Imaging study in nmCRPC
Project Case details and discussion plan Discussion: How frequent would you monitor imaging test? Patient detailing A 72-year-old case with nmCRPC was discussed. The patient had localized Gleason 9 prostate cancer and was diagnosed in 10/2019. Additional parameters were: Radiotherapy + 3 years of ADT planned PSA at diagnosis: 15.4 ng/ml PSA nadir 08/2020: 0.3 ng/ml PSA rise 11/2020: 1.5 ng/ml (conventional imaging no mets) PSA-DT <5 month Apalutamide treatment started 12/2020, PSA now 0.2 ng/ml 3-6 months OR 6-12 months OR When PSA progress ADT: androgen-deprivation therapy; nmCRPC: non-metastatic castration-resistant prostate cancer; PSA: prostate specific antigen
Project Panelist insights and Conclusion Experts shared regional insights about rational management of this case and choice of treatment for such patients. I do not routinely do imaging in my practice. I will look at initial PSA at presentation and determine if PSA is a reliable marker for follow-up, which should be the case most of the time. In nmCRPC, I don t prefer using imaging unless the PSA progresses. A/Prof. Edmund Chiong Imaging tests should be performed at least once a year, irrespective of PSA progression. Dr. Loh Chit Sin In our practice, we largely depend on biochemical follow-up. Imaging is not used routinely. A/Prof. Lee Lui Shiong Two of the panelists agreed that imaging for nmCRPC patients should not be performed on a regular basis. A/Prof. Edmund Chiong further added that imaging can be performed when there is PSA progression. Dr. Loh Chit Sin believed that imaging should be performed at least once a year, irrespective of PSA progression. A/Prof: Associate Professor; nmCRPC: non-metastatic castration-resistant prostate cancer; PSA: prostate specific antigen
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