RADAR 6 & 7 | Detection of Advanced Prostate Cancer Recurrence

Posted by E. David Crawford, MD | May 2023

E. David Crawford, MD, presented “RADAR 6 & 7 – Detection of Advanced Prostate Cancer Recurrence” during the 33rd International Prostate Cancer Update on January 23, 2023, in Vail, Colorado.

How to cite: Crawford, E. David. “RADAR 6 & 7 – Detection of Advanced Prostate Cancer Recurrence.” January 23, 2023. Accessed Nov 2024. https://grandroundsinurology.com/RADAR 6 & 7/

RADAR 6 & 7 – Detection of Advanced Prostate Cancer Recurrence – Summary

E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, reflects on the genesis of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR) working group. It originated from a panel debate among faculty during a previous International Prostate Cancer Update meeting. The debate shed light on the folly of automatically ordering bone and computerized tomography (CT) scans for all patients with Gleason 6 prostate cancer undergoing radical prostatectomy, and the pattern of these scans only showing negative results until it is too late. Soon after, a multidisciplinary group met to form RADAR I, which addressed the unmet need for a consensus on eligibility criteria, type of imaging modality, and the frequency of scanning for detecting metastatic disease. RADAR I pinpointed guidelines and recommendations for early identification of prostate cancer metastasis, and also created the three categories of newly-diagnosed patients–biochemically recurrent patients, and M0 castrate-resistant patients–to direct these guidelines. The project continued in RADAR II, which focused on the concept of “therapeutic layering” in metastatic castration-resistant prostate cancer (mCRPC) patients. After a hiatus, the working group reconvened for RADAR III in response to the advent of PET scanning with new agents, namely 18F-Fluciclovine. Among the main objectives of this iteration were to understand the potential use of novel imaging modalities in prostate cancer, the rationale for obtaining these scans, and how easily these novel imaging modalities could be adopted into medical and urologic oncologists’ practices. RADAR III expanded on the category-directed guidelines from RADAR I, adding when it is appropriate to employ next-generation imaging in the evaluation of newly-diagnosed patients, biochemically recurrent patients, M0 castrate-resistant patients, and M1 castrate-resistant patients. Next, RADAR IV sought to define the concept of “transitional disease.” It illustrated the pathway of prostate cancer from rising PSA, biochemical failure after hormone therapy, to transitional disease–a category containing both metastatic castration-sensitive prostate cancer (mCSPC) and non-metastatic castration-resistant prostate cancer (nmCRPC). This publication stressed that the goal of care for patients who reached this last stage should be to prevent them from progressing along the pathway toward mCRPC. RADAR V focused on implementing the topics from RADAR IV, honing in on the essentiality of preventing progression to advanced disease by not hesitating to perform impactful treatments at the transitional disease stage. RADAR VI notably added recommendations for the use of molecular-targeted imaging (MTi). Finally, RADAR VII applies and synthesizes the guidelines from RADAR VI, setting forth an algorithm for guiding treatment decision-making based on MTi.

About The 33rd Annual International Prostate Cancer Update:

The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. The 33rd iteration of the meeting occurred January 22-25, 2023 in Vail, Colorado. To view more educational presentations from IPCU 33, visit our collection page.

ABOUT THE AUTHOR

E. David Crawford, MD

Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.

About The Author

E. David Crawford, MD

Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles. Dr. Crawford is an internationally recognized expert in benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 810 scientific articles, has published seven textbooks, authored over 60 book chapters, and provided more than 2,200 educational talks for patients and physicians. In an effort to raise public awareness about prostate health, Crawford in 1989 founded the Prostate Conditions Education Council (PCEC). The non-profit organization is comprised of a consortium of leading physicians, health educators, scientists, and men's health advocates. PCEC's advocacy for free or low-cost prostate screening has affected the lives of millions of American men. He currently chairs the PCEC. Crawford is an active member of many national and international organizations, including the American Society of Clinical Oncology, the American Urological Association (AUA), and the American Association for the Advancement of Science. Within the AUA, he has been a member of the Committee to Study Urologic Research Funding and the prostate cancer clinical trials subcommittee. Crawford served on the board of governors, the scientific advisory board of the Southwest Oncology Group, and was chairman of the Genitourinary Cancer Committee for 27 years. This group is the largest clinical trials group in the world. Crawford's involvement in the national prostate cancer arena has been widely recognized. He has received many honors and awards, including the CAP Cure Annual Award for Scientific Presentation in 1999 In 1997, he was presented with a 'Freddie Award" at the AMA International Health and Medical Film Competition for the program, ITV: The Cutting Edge Medical Report (Prostate Cancer: Understanding, Diagnosing, and Defeating), which Crawford hosted with special guest, retired General Norman Schwarzkopf. Crawford again won a prestigious 'Freddie Award" 5 years ago... He is a member of Best Doctors of America and was named Healthcare Provider of the Year in the Denver Metro area by the Denver Business Journal. He has been recognized as one of the Best Doctors of America for the past two decades and is recognized as one of the top 20 urologists in the country, for men, by Men’s Health Magazine. In 2018 he received the honor of being named the Distinguished Alumnus of the Year from the University of Cincinnati School of Medicine. In May of 2019, he received the Presidential citation from the American Urological Association recognizing for his “tireless role in genitourinary cancer research that has benefited countless urologic cancer patients.” He accepted the position of Editor in Chief of Grand Rounds in Urology in June of 2019. In 2021, he was the recipient of the Merle Stringer, M.D. annual award for excellence in medicine by the Florida State Medical Association.

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