Page 10 - Uro_Onco_booklet

Part 6: Staging and Monitoring of mCRPC Treatment

No. Statements
Before starting a new line of treatment, re-staging in
mCRPC should be undertaken as a baseline to monitor
1
any subsequent response to the treatment that may
potentially cause side effects, e.g. chemotherapy.
For re-staging in mCRPC, bone scan and CT scan are
recommended, while MRI and PET scan are optional
depending on available resources and facilities.
2 However, eligibility criteria for imaging, the type of
imaging modality, and the frequency of scanning for
metastatic disease remain undetermined based on
current available evidence.
For treatment monitoring in mCRPC, regular blood
tests (at least three monthly), including PSA, alkaline
phosphatase (ALP) and lactate dehydrogenase (LDH),
3
are highly recommended. If resources are available,
regular follow-up imaging with bone scan or CT scan
can be performed after treatment completion.
If two of three criteria (PSA progression, radiographic
4 progression and clinical deterioration) are fulfilled,
termination of current treatment can be considered.
The treatment can be continued if it is still able to slow
down disease progression (e.g. patient symptoms
5 under control, pain controlled as measured by Brief Pain
Inventory, satisfactory quality of life remaining) and only
causes minimal side effects.
Temporary PSA rise could be observed during the initial
phase of systemic treatment, and sufficient time for
monitoring (3 months) should be considered in order
6
to determine whether it is a PSA flare (initially rising
PSA under therapy, dropping thereafter to values below
baseline) or genuine progression.
10