Therapeutic Advances in Urology (Mar 2025)

The expanding role of next-generation imaging in prostate cancer management: a cross-sectional survey exploring the clinical practice of uro-oncologists in North-Eastern Italy; on behalf of GUONE (Gruppo Uro-Oncologico del Nord-Est)

  • Fabio Matrone,
  • Luca Urso,
  • Rossano Girometti,
  • Jerry Polesel,
  • Matteo Sepulcri,
  • Francesco Pierantoni,
  • Paolo Artioli,
  • Anna Caliò,
  • Irene Campo,
  • Alessia Cimadamore,
  • Enrico Munari,
  • Luca Ongaro,
  • Valentina Orlando,
  • Camilla Sachs,
  • Alessandro Veccia,
  • Alessandro Antonelli,
  • Roberto Bortolus,
  • Matteo Brunelli,
  • Orazio Caffo,
  • Laura Evangelista,
  • Matteo Salgarello,
  • Umberto Basso,
  • Rocco De Vivo,
  • Mario Gardi,
  • Andrea Guttilla,
  • Marco Andrea Signor,
  • Fabio Zattoni,
  • Filippo Alongi,
  • Giampaolo Montesi,
  • Gianluca Giannarini

DOI
https://doi.org/10.1177/17562872251321971
Journal volume & issue
Vol. 17

Abstract

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Background: Next-generation imaging (NGI) technologies such as multiparametric magnetic resonance imaging (mpMRI) and total-body NGI (tbNGI) methodologies including choline, fluciclovine or PSMA positron emission tomography/computed tomography (PET/CT), whole-body MRI (wbMRI), and PET/MRI are becoming increasingly available, but their use in different prostate cancer (PCa) settings is under debate. The Gruppo Uro-Oncologico del Nord-Est (GUONE) designed a survey to explore the current clinical practice of NGI utilization in a specific macro-region in North-Eastern Italy. Methods: A cross-sectional survey was conducted by administering an anonymous online multiple-choice questionnaire to uro-oncologists practicing in North-Eastern Italy, using the Google Forms ® platform. The use of NGI was investigated in the following settings: primary staging of PCa; management of biochemical (BCR) and local recurrence (LR); re-staging in metastatic hormone-sensitive PCa (mHSPC), metastatic castration-resistant PCa (mCRPC), non-metastatic CRPC (nmCRPC), and oligometastatic PCa (OMPC). Results: In all, 100 uro-oncologists accessed and completed the survey. In primary N/M staging, the use of tbNGI increases in accordance with NCCN risk groups. Re-staging with choline and PSMA PET/CT is the prevalent choice in the case of BCR after radical prostatectomy. Moreover, when the PSA value rises, there is a parallel increased use of tbNGI. When an LR is suspected, PSMA PET/CT plus mpMRI is the most selected option. Re-staging with tbNGI (PSMA PET/CT) is preferred in mHSPC, mCRPC, and nmCRPC patients in case of progression of disease. Overall, there is a limited use of wbMRI and PET/MRI in all the settings investigated. Conclusion: Our survey describes the expanding role of NGI modalities in the management of PCa patients, from primary staging and re-staging to management of advanced PCa and assessment of treatment response. Several controversial issues have emerged, which need to be addressed in prospective studies to develop a standardized and cost-effective NGI utilization.