New Imaging Techniques in Prostate Cancer

Rapid advances in diagnostic imaging have been developed in parallel with the changes in the contemporary management of prostate cancer. Increasingly, clinical management and decision making in prostate cancer are influenced by technologies such as magnetic resonance imaging-targeted prostate biopsies for men with elevated PSA, imaging for active surveillance, and nuclear medicine studies for men with advanced or recurrent prostate cancer. Furthermore, novel imaging techniques have been developed such as hyperpolarized MRI, choline and prostate-specific membrane antigen positron emission tomography that exploit features like the unique metabolism in prostate cancer tissues, as well as altered glycoprotein conformation. These technologies have allowed for the identification of tiny foci of prostate cancer in men with early biochemical recurrence, greatly surpassing the limitations of traditional morphological imaging. With promising findings, studies are ongoing to uncover the clinical application of these imaging modalities. Ultimately, several factors such as cost-effectiveness and the overall reduction in disease mortality will dictate the implementation of these imaging technologies in the future. This chapter provides an overview on new and emerging prostate imaging techniques that can be used in the diagnosis of primary cancer as well as the staging and detection of metastatic disease.