Imaging Studies in Metastatic Urogenital Cancer Patients Undergoing Systemic Therapy: Recommendations of a Multidisciplinary Consensus Meeting of the Association of Urological Oncology of the German Cancer Society

Department of Urology, RWTH University, Aachen, Germany. aheidenreich @
Urologia Internationalis (Impact Factor: 1.43). 07/2010; 85(1):1-10. DOI: 10.1159/000318985
Source: PubMed


Imaging studies are an integral and important diagnostic modality to stage, to monitor and follow-up patients with metastatic urogenital cancer. The currently available guidelines on diagnosis and treatment of urogenital cancer do not provide the clinician with evidence-based recommendations for daily practice.
To develop scientifically valid recommendations with regard to the most appropriate imaging technique and the most useful time interval in metastatic urogenital cancer patients undergoing systemic therapy.
A systematic literature review was performed searching MedLine, Embase and Web of Science databases using the terms prostate, renal cell, bladder and testis cancer in combination with the variables lymph node, lung, liver, bone metastases, chemotherapy and molecular therapy, and the search terms computed tomography, magnetic resonance imaging and positron emission tomography were applied. A total of 11,834 records were retrieved from all databases. The panel reviewed the records to identify articles with the highest level of evidence using the recommendation of the US Agency for Health Care Policy and Research.
Contrast-enhanced computed tomography remains the standard imaging technique for monitoring of pulmonary, hepatic and lymph node metastases. Bone scintigraphy is still the most widely used imaging technique for the detection and follow-up of osseous lesions. For clinical trials it might be replaced by either PET-CT or MRI of the skeletal axis. Response assessment for patients treated with cytotoxic regime is best performed by the RECIST/WHO criteria; treatment response to molecular triggered therapy is best assessed by CT evaluating decrease in tumor size and density. Cross-sectional imaging studies for response assessment might be obtained after each 2 cycles of systemic therapy to early stratify responders from non-responders.

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    ABSTRACT: The evolution of urological imaging has had a major impact on the diagnosis and treatment of urological diseases since the discovery of the X-ray by Roentgen in 1895. Early developments included plain films of the abdomen, retrograde urographic techniques, development of contrast media, excretory urography, renal mass puncture, renal angiography, cystography and nuclear medicine procedures. These procedures led to the maturation of the specialties of diagnostic radiology and urology, and the development of the subspecialties of pediatric urology and urological radiology during the first seven decades of the 20th century. Subsequently, many imaging advances have occurred leading to changes in diagnosis and management of urological patients. Ultrasound and cross-sectional imaging technologies (computed tomography and magnetic resonance imaging) are increasingly applied in urological evaluation, treatment and surveillance. Current developments include dual energy computed tomography, positron emission tomography computed tomography, renal donor and renal transplant imaging, prostate magnetic resonance imaging, and microbubble contrast enhanced ultrasound. Imaging advances will continue. It is the responsibility of all physicians to assess the advantages of new developments while weighing those advantages against the additional radiation exposure and the costs associated with new procedures.
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