Prof Bertrand Tombal, an oncologic urologist from Clinique Universitaires Saint-Luc in Brussels, delivered a presentation on metastatic hormone-naïve prostate cancer during a specialized session. This area of study has seen significant advancements with the introduction of various androgen receptor pathway inhibitors (ARPI), including abiraterone, enzalutamide, darolutamide and apalutamide. The challenge now is to determine the most appropriate treatment strategy, considering factors such as chemotherapy and radiotherapy. Prof Tombal discussed whether next-generation imaging, specifically PET-PSMA and whole-body MRI, significantly impacts clinical practice in this context, especially given the shift away from conventional imaging techniques in countries like Belgium.
In the realm of treatment selection, next-generation imaging does not always influence decisions, as the standard approach involves administering ARPI in addition to androgen deprivation therapy for all patients. Prof Tombal emphasised that the potential benefits of docetaxel and radiotherapy are not solely determined by tumour volume. Therefore, performing a PET-PSMA scan on patients with confirmed metastases may not offer substantial added value.
The role of PET-PSMA in targeted therapy for metastatic disease, particularly in patients with oligometastases, was also explored. This situation presents a paradox, as there is a recognised need for PET-PSMA scans, but the full validation of metastatic targeted therapy remains a work in progress. Although a couple of phase 2 trials suggest that PET-PSMA imaging might delay the initiation of androgen deprivation therapy, the overall clinical benefits are still uncertain. Moreover, recent evidence indicates that hormone therapy may be more effective in patients with rising PSA levels.
In conclusion, the introduction of new imaging technologies necessitates careful consideration when evaluating and reclassifying patients. These cutting-edge tools have not yet demonstrated their definitive clinical utility for the patients, highlighting the importance of ongoing research and assessment in this evolving field.
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