Maria De Santis, MD: Radiologic Diagnostics in Prostate Cancer

The Group Room at the 2012 European Society for Medical Oncology (ESMO) Congress in Vienna was made possible, in part, by:

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VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel for The Group Room at the ESMO 2012 Congress happening now in Vienna.  And, I’m happy to introduce you to Dr. Maria De Santis who is the Director of the Genitourinary Program at the Kaiser Franz Josef Hospital here in Vienna and Chair of the ESMO GU Non-Prostate Task Force.  Welcome to The Group Room Program.    

Maria De Santis, MD: Kaiser Franz Josef Hospital, Vienna

I thank you for the kind invitation.  I’m happy to be here.

Selma Schimmel, Founder & CEO, Vital Options International

What do you think about radiologic diagnostics to evaluate disease progression in patients that did not have chemotherapy?

Maria De Santis, MD: Kaiser Franz Josef Hospital, Vienna

Well, this is a very interesting field and in prostate cancer the question about radiologic evaluation of response and progression is difficult because we have mostly bone disease we are dealing with.   And, in bone disease there is the problem that it is difficult to evaluate the bone with bone scan, with CT scan or with MRI, and nowadays still bone scan is the standard.   So, in patients not treated with chemotherapy, but treated with hormonal treatment, or with androgen biosynthesis inhibitors or antiandrogens, a sort of new endpoint was created following the Prostate Cancer Working Group Guidelines Two and this new way of looking at progression rather than at response, in the studies, was implemented in the two new trials with abiraterone and with enzalutamide.  Here, the principle is that in bone scan, we call for two new lesions on the bone scan to evaluate a progression which has been actually confirmed after some weeks so that we can be sure that this is really a progression and it is not a pseudo-progression caused by a flare in the bone.  And, this is really important in this patient population because up to 30% of patients might have a sort of bone flare and we should not see this patient as progressing just because there is a flare and uptake in the bone scan that is not really a tumor.

Selma Schimmel, Founder & CEO, Vital Options International

Does, PET, CT, or MRI play any role in diagnostics and evaluation?

Maria De Santis, MD: Kaiser Franz Josef Hospital, Vienna

Not that much PET, CT, when evaluating bone.  But MRI is very good for diagnostics, for example, a basic evaluation of the spinal cord to exclude soft tissue components of bone metastasis that might cause spinal cord compression.  For me, MRI of the spine has become a sort of standard, but this is a sort of special situation in my country where I can afford to do this in patients where I think it is important.  But, MRI has not become a standard, especially not a standard for bone evaluation within clinical trials.  There, we have to use those standards to make things comparable concerning the endpoints.   And, we try to use all the same standard evaluations, like bone scan, according to the Prostate Cancer Working Group Two criteria and especially the radiographic progression-free survival in those trials, we thought chemotherapy with the new hormonal treatments.

Selma Schimmel, Founder & CEO, Vital Options International

Thank you, Dr. Maria De Santis, Director of the Genitourinary Program at the Kaiser Franz Josef Hospital here in Vienna and Chair of the ESMO GU Non-Prostate Task Force.

Maria De Santis, MD: Kaiser Franz Josef Hospital, Vienna

Thank you for the kind invitation.

END OF VIDEO

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