Prostate cancer PET tracers: essentials for the urologist

In the past, positron emission tomography (PET) has played a relatively limited role in prostate cancer imaging. However, in recent years, several new PET tracers have emerged, offering potential improvements in diagnostic performance for both the detection of prostate cancer metastases at initial staging and the localization of recurrent disease.

We reviewed the literature for prostate cancer PET tracers that are either being used for patient management or being evaluated in clinical research trials. For each tracer, we compiled clinically relevant background information and evidence supporting clinical use, with the intention of providing a high-yield primer for urologists managing patients with prostate cancer.

18F-FDG, 18F-NaF, ¹¹C-choline, and 18F-fluciclovine have all proven useful for prostate cancer imaging, though the utility of each of these tracers is limited to targeted management questions and particular clinical settings. In contrast, the newer prostate-specific membrane antigen (PSMA) agents may prove useful as general purpose PET tracers for prostate cancer imaging. Numerous other novel PET tracers have shown promising results in pre-clinical studies.

Basic knowledge of these PET tracers, specifically their strengths, weaknesses, and indications for use, is essential to urologists and other physicians caring for patients with prostate cancer.