New developments in the imaging of metastatic prostate cancer

In the last 10 years, metastatic castration-resistant prostate cancer (mCRPC) treatment has completely changed. Several new agents have been shown to increase mCRPC patients' overall survival. The importance to define castration-resistant prostate cancer as metastatic and to enable earlier detection of cancer progression set a renewed role for prostate cancer (PCa) imaging.

Recently published data on molecular imaging of metastatic PCa have focused on diagnostic accuracy, clinical impact and prognostic value of newer techniques using PET and MRI.

Molecular imaging techniques are more sensitive and accurate than conventional imaging for the early detection of lymph node and bone metastases. New capabilities offered by PET imaging, MRI lymphography and whole-body MRI are consolidating the role of imaging in metastatic PCa management. These techniques are particularly useful for detecting metastasis, a driver for treatment initiation, especially in patients under androgen-deprivation therapy. Moreover, there is an increasing body of evidence supporting the use of metabolic PET and computed tomography as a prognostic biomarker able to predict survival in patients with metastatic PCa.