Imaging approaches with advanced prostate cancer: techniques and timing.
In conjunction with biomarkers, imaging is an important component of the diagnostic work up and subsequent management of men with prostate cancer. The relevant literature was retrieved from a search of MEDLINE with appropriate key words. Osseous metastases develop in close to 90% of patients with metastatic prostate cancer, thus making bone scans (single photon, using Tc-99m labeled phosphonates) the mainstay of imaging in advanced prostate cancer. Bone scans are limited by their lack of specificity and an unclear relationship between bone scan changes and disease progression or response to therapy. In addition to Tc-99m bone scans, other technologies that accurately identify of sites of active disease would considerably aid castration resistant prostate cancer (CRPC) management. Accordingly, metabolic imaging, cell surface receptor targeting, and magnetic resonance imaging (MRI) are being studied for their role in evaluating metastatic disease. Due to the increasing availability of advanced imaging modalities, the optimal modality and appropriate clinical time point for its use remains unclear. A number of imaging modalities are currently or imminently available for use in advanced prostate cancer. Future research will focus on the appropriate incorporation of these modalities in prostate cancer management.