The 2015 update of the guidelines for prostate cancer from the National Comprehensive Cancer Network (NCCN) marks the 20th annual edition of the guidance.
The update contains three major changes, which are related to imaging, molecular testing, and the systemic treatment of castration-resistant disease, said James Mohler, MD, who chairs the NCCN panel for prostate cancer, in an interview with Medscape Medical News.
The section on imaging has new recommendations on the use of PET for bone scans and on a type of MRI for the imaging of the gland.
The revisions reflect “newly appreciated uses of imaging,” said Dr Mohler, who is from the Roswell Park Cancer Institute in Buffalo, New York.
Multiparametric (mp)MRI “can be used in the staging and characterization of prostate cancer” and “to better risk stratify men who are considering active surveillance,” reads the guidance.
mpMRI images are defined as those acquired with at least one more sequence in addition to the anatomic T2-weighted images, such as diffusion-weighted imaging and dynamic contrast images.
“MRI can be an invaluable tool in the overall management of prostate cancer,” said Marc B. Garnick, MD, from Beth Israel Deaconess Medical Center in Boston, who is not involved with the NCCN and was asked for comment.
“In my own practice, we often use MRI to more fully stage patients after diagnosis. It is particularly helpful in detecting anterior tumors, high-grade lesions, and hints that there may be either seminal vesicle, extracapsular spread, or both. It can also point out suspicious nodes and, for the rare patient with rectal wall involvement, it can be helpful,” he told Medscape Medical News in an email.
MRI can be an invaluable tool in the overall management of prostate cancer.
The use of mpMRI in active surveillance is especially helpful, added Dr Garnick, who is editor-in-chief of the Harvard Medical School Annual Report on Prostate Diseases.
“MRI staging is a very important staging study for any man who is considering active surveillance, since it can definitely identify so-called anterior tumors than can be missed with prostate needle biopsies,” he explained.
Dr Garnick noted that mpMRI can also be used to monitor men on active surveillance, which is a recommendation not in the NCCN guidance.
“Because so many men do not want to undergo multiple prostate needle biopsies as part of their active surveillance programs, I have used MRI restaging as a surrogate…for monitoring men on active surveillance programs,” he said.
