Imaging of distant metastases of prostate cancer

The detection of distant metastases at the initial diagnosis of prostate cancer (PCa) establishes the treatment approach and has a prognostic value, nevertheless it is not well established. Since proposed staging approaches often contradict each other, we aimed to compare the current imaging techniques for staging of advanced PCa, including future applications of the most innovative methods.

Conventional imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have been employed for metastatic staging (both N and M staging) of men with high-risk PCa, but surgical pelvic dissection remains the gold standard for N staging. However, functional MRI by using diffusion-weighted imaging, MR lymphography (MRL) with ultra-small paramagnetic iron oxide particles (USPIO), and hybrid PET/MRI imaging showed both high sensitivity and high specificity for nodal staging and depicting metastases. The standard of practice for M staging in PCa includes the radionuclide bone scan and targeted X-ray film, but their performance has generally been poor. Recently, MRI showed promising results with applications in both local and distant staging. Finally, with the development of new PET tracers, PET/CT and PET/MRI offer a combination of excellent pharmacokinetic characteristics, functional information, and precise anatomic localization and morphological correlation of tumor lesions.

Medical oncology (Northwood, London, England). 2018 Sep 14*** epublish ***

Filippo Pesapane, Marcin Czarniecki, Matteo Basilio Suter, Baris Turkbey, Geert Villeirs

Department of Health Sciences, Postgraduation School of Radiodiagnostic of Milan, Milan, Italy. ., Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Department of Medical Oncology, ASST Sette laghi, Varese, Italy., Department of Radiology, Ghent University Hospital, Ghent, Belgium.


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