- The American Society of Clinical Oncology (ASCO) has issued guidelines on optimum imaging strategies for advanced prostate cancer.
- All patients should receive conventional imaging (CI; defined as CT, bone scan, and/or prostate MRI) and/or next-generation imaging (NGI; defined as positron emission tomography or whole-body MRI) according to the clinical scenarios.
- Newly diagnosed high-risk/very high risk localized disease:
- When CI is negative, suspicious/equivocal, NGI may add clinical benefit.
- Rising PSA after prostatectomy and negative CI:
- Offer NGI if salvage radiotherapy is contemplated, but not for men who are ineligible or unwilling to receive salvage local/regional therapy.
- Rising PSA after radiotherapy and negative CI:
- NGI can be offered if salvage local/regional therapy is contemplated.
- Hormone-sensitive metastatic disease at initial diagnosis or after initial treatment:
- NGI may clarify the burden of disease.
- Nonmetastatic castration-resistant disease:
- NGI can be offered only if a change in clinical care is contemplated.
- Metastatic castration-resistant disease:
- PSA progression alone should not be the sole reason to change therapy; CI can be used for initial evaluation and should be continued to facilitate changes.
- NGI may be used in an individualized manner when subclinical metastasis is suspected despite negative CI.
- Radiographic progression on CI:
- NGI should not be routinely offered.