David Utz

L. Michael Glodé, MD, FACP, Professor Emeritus of Medical Oncology and the former Robert Rifkin Chair for Prostate Cancer Research at the University of Colorado Cancer Center in Aurora, Colorado, presents the case for standard imaging over second-generation technology in urologic oncology. One compelling reason to consider standard imaging like bone scans is the extensive data that have culminated in criteria on when to order routine scans such as these. Advanced imaging currently lacks both the wealth of data and scanning criteria, leading to questions about the frequency of false positives and false negatives and whether radiologist training is consistent. Dr. Glodé observes that we understand the limitations of conventional imaging, adding that there is insufficient data to make any such determination about the accuracy of second-generation scans. Since trials studying second-generation anti-androgens over the last few years have employed conventional imaging, Dr. Glodé suggests the more sensitive second-generation imaging could potentially deny patients with now-visible metastases access to some drugs based on eligibility criteria. The cost of newer imaging techniques is also prohibitive, especially if they do not replace current scans or change approaches to treatment. He concludes that the level 1 evidence on treatment of non-metastatic castration-resistant prostate cancer using conventional scans weighed against the cost of second-generation scans and the potential for inconsistent application of newer technology suggest that doctors should better utilize current standard imaging.