Imaging Diagnosis and Follow-up of Advanced Prostate Cancer

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.25
Procedures: 0.25
Abdomen and Pelvis: 0.25

Magnetic Resonance Imaging: 0.25
Procedures: 0.25
Body: 0.25

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Radionuclides and Radiopharmaceuticals: 0.25
Other Imaging Procedures: 0.75

Registered Radiologist Assistant: 0.25
Procedures: 0.25
Abdominal Section: 0.25

Radiation Therapy: 0.25
Procedures: 0.25
Treatment Sites and Tumors: 0.25

Outline

1. Introduction
2. Advanced Prostate Cancer Imaging at Staging and during Follow-up
3. Imaging Assessment of Advanced Prostate Cancer
   1. Detection of Metastatic Nodal Disease
      1. Conventional CT Imaging
      2. MRI
      3. PET/CT and PET/MRI
   2. Detection of Bone Metastases
      1. Standard Bone Scan and CT
      2. MRI
      3. PET/CT and PET/MRI
   3. Other Radiopharmaceuticals to Detect Disease in Advanced Prostate Cancer
4. Oligometastatic Prostate Cancer at Initial Staging and Disease Relapse: Changing Paradigm
5. Detection of Therapeutic Response
   1. Assessment of Soft-Tissue Disease Response
   2. Assessing response of Bone Metastases
      1. Radionuclide Bone Scan
      2. Radiopharmaceuticals for PET Imaging
      3. Circulating Tumor Cells
6. Theranostics: Diagnosing and Treating Advanced Prostate Cancer with Radiopharmaceuticals
7. Potential and Challenges of Next-Generation Imaging

Objectives

Upon completion of this course, students will:

1. list areas associated with disease spread in locally advanced prostate cancer
2. identify what characterizes castration-resistant prostate carcinoma
3. explain how modern imaging plays a role in the medical management of advanced prostate cancer
4. identify next generation imaging modalities
5. understand how prostate cancer is categorized into low, intermediate, high and locally advanced risk
6. understand the role of imaging in risk stratification
7. list the areas that prostate cancer most commonly spread to
8. understand which imaging modalities would be ideal for both the detection of nodal metastases and to guide excision during surgery
9. explain the apparent diffusion coefficient values of malignant nodes
10. isolate the investigational imaging technique that improves sensitivity and specificity for malignant lymph node detection
11. identify which molecular PET technique is not ideal for assessing prostate cancer
12. identify which molecular PET technique is not ideal for assessing soft tissue disease
13. list a second-generation imaging technique with higher spatial resolution that has shown promise for disease staging and biochemical relapse
14. understand the advantages associated with SPECT/CT bone scanning and lesion detection
15. identify the imaging modalities that underestimate the presence and extent of bone lesions
16. identify the imaging modalities that are more sensitive for detecting bone metastases
17. list the advantages of ¹⁸F NaF PET/CT over SPECT bone scanning
18. name the radiopharmaceutical that has been studied for wild-type androgen receptor expression
19. define oligometastatic disease
20. identify the most common sites of oligometastatic disease relapse
21. identify the imaging modality best suited for depicting bone metastases in a CRPC patient with elevated PSA
22. understand the relationship between PSA levels and metastatic CRPC
23. explain RECIST version 1.1 as it applies to advanced prostate cancer
24. identify the validation criteria used with bone scanning to evaluate disease progression following treatment
25. describe the bone scan index
26. identify which imaging modalities are confounded by the flare phenomenon
27. understand the components of MET-RADS-P
28. identify areas that can lead to low circulating tumor cells in the presence of widespread disease
29. define theranostics
30. list radionuclides associated with theranostics
31. identify an alpha emitting radionuclide being investigated as a theranostic
32. identify observations, following treatment, that are associated with longer overall survival
33. understand how ⁶⁸Ga PSMA PET screening is predictive of decreasing PSA levels following radionuclide treatment
34. list the PET agent that can guide future theranostics by providing insight into both receptor expression and signaling pathways
35. list roles that next-generation imaging will continue to play in the assessment of advanced prostate cancer