Novel imaging techniques reshape the landscape in high-risk prostate cancers

High-risk prostate cancers (PCa), that is, those with prostate-specific antigen greater than 20 ng/dl, Gleason Score of at least 8, or extraprostatic spread, are nowadays commonly treated by surgery and radiotherapy combined with a fixed period of systemic treatment. Implementing these strategies requires an exhaustive assessment of metastatic spread. This review addresses the latest development in integrated imaging techniques.

In contrast to the progress that has been made in PCa treatment, diagnostic strategies have not much evolved. Most guidelines still recognize (99m)Tc bone scintigraphy and computed tomography (CT) as cornerstone modalities to assess metastatic spread in bones and lymph nodes. Therefore, modern imaging techniques should primarily focus on these two targets. PET with various tracers, including (11)C or (18)F-choline and (18)F-sodium fluoride, and MRI with or without diffusion-weighted imaging are competing to supplant bone scan and CT scan as reference imaging techniques. This review focuses on the latest development of these techniques and analyses their potential impact in everyday urology practice.

Although certain hurdles remain, PET and whole-body MRI have the ability to supplant (99m)Tc bone scan and CT as upfront test to assess metastatic spread in high-risk PCa.