April 2026

ONCOLOGY

SCANS CAN REVEAL HIDDEN PROSTATE CANCER PROGRESSION

Featuring: ​​Maha Hussain, MD
​​
​A large analysis of two major clinical trials has found that the spread of prostate cancer can be detected on imaging scans even when biomarkers remain stable in patients treated with androgen receptor inhibitors, according to the study published in the Journal of Clinical Oncology. 

The findings, drawn from more than 2,500 patients, raise questions about how physicians monitor prostate cancer treatment response and suggest that relying solely on PSA levels may leave some disease progression undetected. 

​Examining the Association of PSA Progression With Imaging Progression
PSA has long been a mainstay of prostate cancer management. But investigators behind the new study found that in a meaningful subset of patients receiving the drug enzalutamide, radiographic progression occurred without a corresponding rise in PSA. 

The analysis examined data from two large trials: one that enrolled patients with metastatic hormone-sensitive prostate cancer and another that studied patients with nonmetastatic castration-resistant prostate cancer.  

In both trials, radiographic progression without PSA progression was substantially more common among patients treated with enzalutamide plus androgen-deprivation therapy than among patients receiving control treatments. 

“What was interesting is that in both of these trials, there were patients who actually progressed, but their PSA never went up,” says study co‑author Maha Hussain, MD. This data indicates that radiographic progression represents a worsening of disease, not merely an incidental finding, Hussain said. 

A More Nuanced Approach Necessary
Together, the findings challenge the long-standing assumption that PSA trends alone are sufficient to monitor prostate cancer disease status including response or progression, particularly in patients receiving potent androgen receptor inhibitors like enzalutamide. When it comes to tracking prostate cancer progression, what clinicians can’t see in the blood may still show up on the scan, Dr. Hussain shares. 

“Anytime we see scans looking worse, if it doesn’t make sense — meaning this does not seem like fitting within what the prostate cancer is doing — it’s critical to biopsy, especially if people develop new metastases in the liver or in the lung,” she says. 

The study was supported by Pfizer Inc. and Astellas Pharma Inc. 

Read more on the Northwestern University Feinberg School of Medicine News Center.
​Maha Hussain, MD, the Genevieve E. Teuton Professor of Medicine in the Division of Hematology and Oncology and member of Robert H. Lurie Comprehensive Cancer Center, was a co-author of the study.

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