<p><strong> </strong><strong>Clinicians should assess nmCRPC patients for development of metastatic disease using conventional or PSMA PET imaging at intervals of 6 to 12 months. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>In addition to monitoring PSA, routine use of conventional or PSMA PET imaging should be integrated into monitoring the disease status of men with nmCRPC. The suggested interval of imaging is 6 to 12 months, with the exact interval determined by the PSADT calculation, the development of symptoms, and patient/physician preference. A PSADT of ≤10 months is associated with a high risk of developing metastatic disease or dying from prostate cancer.<sup>108</sup> Continued monitoring with routine imaging is recommended for patients on ADT alone and patients on ADT plus an AR antagonist (apalutamide, darolutamide, enzalutamide). In patients with mCRPC treated with enzalutamide prior to chemotherapy in the PREVAIL trial, radiographic progression occurred in 24.5% of patients without PSA progression, suggesting that routine imaging can identify a significant portion of patients with radiographic progression who would otherwise not be identified.<sup>108</sup> The Panel extrapolates this principle to the nmCRPC population, particularly for men on additional AR antagonist treatment.</p>
<p>Once a patient has started ART therapy for nmCRPC as noted below, the imaging intervals can be extended to annually in the absence of other indicators of progression.</p>