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Attitudes, practices and perspectives on imaging strategies in prostate cancer: a national cross-sectional survey involving expert radiation oncologists on behalf of AIRO (Italian association of radiotherapy and clinical oncology) GU group

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Abstract

Although high sensitive imaging modalities such as MRI and PSMA PET/CT are becoming available for prostate cancer (PCa), the clinical benefit of an earlier detection of subclinical disease remains yet undetermined. Given these uncertainties, univocal recommendations are often lacking. The present survey was therefore developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of expert radiation oncologists and delineate a representation of current clinical practice in our country. A nationwide cross-sectional survey was conducted in Italy by administering an anonymous questionnaire to experienced radiation oncologists, representative of the genitourinary (GU) tumor board at their Institution, using the cloud-based platform SurveyMonkey®. For each question, a consensus was achieved when ≥ 75% of the responders agreed on the same response. Thirty nine AIRO members from different Italian centers who were deemed experts in GU field accessed the proposed survey and completed all sections. Explored topics included staging of organ-confined disease, management of biochemical and local recurrence, imaging in the metastatic setting, imaging following metastasis-directed therapy (MDT), and future considerations. Response rate for single item of the questionnaire ranged between 51.2% and 100%. Expert GU AIRO members agree that advanced molecular and functional imaging are expanding their role in local and distant staging of PCa, as well as in the oncologic management and in the assessment of treatment response. However, many controversial issues still exist on the best timing for a diagnostic evaluation and the most appropriate imaging to aim at this purpose.

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The datasets supporting the conclusions of this article are included within the article.

Abbreviations

PCa:

Prostate cancer

MRI:

Magnetic resonance imaging

PSMA PET/CT:

Prostate-specific membrane antigen positron emission tomography/computed tomography

AIRO:

Italian association of radiotherapy and clinical oncology

GU:

Genitourinary

MDT::

Metastasis-directed therapy

BS:

Bone scan

RCT:

Randomized controlled trial

(mp)MRI:

Multiparametric magnetic resonance imaging

RT:

Radiotherapy

PSA:

Prostate-specific antigen

PSA DT:

Prostate-specific antigen doubling time

mCRPC:

Metastatic castration-resistant prostate cancer

NED:

No evidence of disease

EAU:

European association of urology

NCCN:

National comprehensive cancer network

bNED:

Biochemical no evidence of disease

IRCCS:

Institute of Clinical and Scientific Research

References

  1. Murphy DG, Sweeney CJ, Tombal B. ‘“Gotta Catch ”em All’’, or Do we? Pokemet approach to metastatic prostate cancer. Eur Urol. 2017;72:1–3.

    Article  Google Scholar 

  2. Perera M, Papa N, Roberts M, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol. 2020;77:403–17.

    Article  Google Scholar 

  3. Hicks RJ, Murphy DG, Williams SG. Seduction by sensitivity: reality, illusion, or delusion? The challenge of assessing outcomes after PSMA imaging selection of patients for treatment. J Nucl Med. 2017;58:1969–71.

    Article  CAS  Google Scholar 

  4. Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79:243–62.

    Article  CAS  Google Scholar 

  5. Hofman MS, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multi-centre study. Lancet. 2020. https://doi.org/10.1016/S0140-6736(20)30314-7.

    Article  PubMed  Google Scholar 

  6. Van den Broeck T, Van den Bergh RC, Arfi N, et al. Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer a systematic review. Eur Urol. 2019;75:967–87.

    Article  Google Scholar 

  7. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. https://uroweb.org/guideline/prostate-cancer/#6.

  8. Bossi A, Blanchard Fanti S. Contemporary imaging technologies for men with rising prostate-specific antigen after radical prostatectomy and before early salvage irradiation: where do we stand? Eur Urol Oncol. 2021;4(3):356–7.

    Article  Google Scholar 

  9. Francolini G, Timon G, Matrone F, et al. Postoperative radiotherapy after upfront radical prostatectomy: debated issues at a turning point-a survey exploring management trends on behalf of AIRO (Italian association of radiotherapy and clinical oncology). Clin Transl Oncol. 2021. https://doi.org/10.1007/s12094-021-02665-y.

    Article  PubMed  Google Scholar 

  10. Jani AB, Schreibmann E, Goyal S, et al. 18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial. Lancet. 2021;397(10288):1895–904.

    Article  CAS  Google Scholar 

  11. Alongi F, De Bari B, Franco P, et al. AIRO young and AIRO prostate cancer working group. The PROCAINA (PROstate CAncer INdication Attitudes) project (Part I): a survey among Italian radiation oncologists on postoperative radiotherapy in prostate cancer. Radiol Med. 2013;118(4):660–78.

    Article  CAS  Google Scholar 

  12. Schaeffer E, Srinivas S, Antonarakis ES, et al. Prostate cancer, version 2.2021 featured updates to the NCCN guideline. J Natl Compr Canc Netw. 2021;19(2):134–43. https://doi.org/10.6004/jnccn.2021.0008.

    Article  CAS  PubMed  Google Scholar 

  13. Cornford P, van den Berger R, Bries E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II—2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol. 2021;79:263–82.

    Article  CAS  Google Scholar 

  14. Parker C, Castro E, Fizari K, et al. Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and followup. Ann Oncol. 2020;31:v1119-1134.

    Article  Google Scholar 

  15. Virgo S, Rumble RB, de Wit R, et al. Initial management of noncastrate advance, recurrent, or metastatic prostate cancer: ASCO guideline update. J Clin Oncol. 2021;39:1274–305.

    Article  Google Scholar 

  16. Gillessen S, Attard G, Beer TM. Management of patients with advanced prostate cancer: report of the advanced prostate cancer consensus conference 2019. Eur Urol. 2020;77(4):508–47.

    Article  CAS  Google Scholar 

  17. Crawford ED, Koo PJ, Shore N, et al. A clinician’s guide to next generation imaging in patients with advanced prostate cancer (RADAR III). J Urol. 2019;201(4):682–92.

    Article  Google Scholar 

  18. Fizazi K, Shore N, Tammela TL, et al. Nonmetastatic, castration-resistant prostate cancer and survival with darolutamide. N Engl J Med. 2020;383:1040–9.

    Article  CAS  Google Scholar 

  19. Sternberg C, Fizazi K, Saad F, et al. Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2020;382:2197–206.

    Article  CAS  Google Scholar 

  20. Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. Eur Urol. 2021;79:150–8.

    Article  CAS  Google Scholar 

  21. Vickers AJ, Brewster SF. PSA velocity and doubling time in diagnosis and prognosis of prostate cancer. Br J Med Surg Urol. 2012;5:162–8.

    Article  Google Scholar 

  22. Farolfi A, Hadaschik B, Hamdy FC, et al. Positron emission tomography and whole-body magnetic resonance imaging for metastasis-directed therapy in hormone-sensitive oligometastatic prostate cancer after primary radical treatment: a systematic review. Eur Urol 2021 (in press). https://doi.org/10.1016/j.euo.2021.02.003

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Acknowledgements

Not applicable.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Radiation Oncology, School of Medicine and Surgery—University of Milan Bicocca, Milan, Italy

    Raffaella Lucchini & Stefano Arcangeli

  2. Radiotherapy Department, University of Florence, Florence, Italy

    Giulio Francolini

  3. Department of Radiation Oncology, Centro di Riferimento, Oncologico di Aviano CRO-IRCCS, Aviano, PN, Italy

    Fabio Matrone

  4. Radioterapia Oncologica, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Giorgia Timon

  5. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy

    Ciro Franzese

  6. Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy

    Giulia Marvaso & Barbara Alicja Jereczek-Fossa

  7. Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy

    Paolo Borghetti

  8. Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy

    Luca Nicosia

  9. Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy

    Luca Eolo Trodella

  10. Radiation Oncology, “G. D’Annunzio” University, Via dei Vestini, 66100, Chieti, Italy

    Annamaria Vinciguerra

  11. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Giulia Marvaso & Barbara Alicja Jereczek-Fossa

Authors
  1. Raffaella Lucchini
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  2. Giulio Francolini
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  4. Giorgia Timon
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  7. Paolo Borghetti
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  8. Luca Nicosia
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  11. Barbara Alicja Jereczek-Fossa
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  12. Stefano Arcangeli
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Corresponding author

Correspondence to Raffaella Lucchini.

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This trial was approved by the local institutional ethics committee.

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Lucchini, R., Francolini, G., Matrone, F. et al. Attitudes, practices and perspectives on imaging strategies in prostate cancer: a national cross-sectional survey involving expert radiation oncologists on behalf of AIRO (Italian association of radiotherapy and clinical oncology) GU group. Med Oncol 39, 3 (2022). https://doi.org/10.1007/s12032-021-01597-5

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