Diagnostic imaging to detect and evaluate response to therapy in bone metastases from prostate cancer: current modalities and new horizons

Different therapeutic options for the management of prostate cancer (PC) have been developed, and some are successful in providing crucial improvement in both survival and quality of life, especially in patients with metastatic castration-resistant PC. In this scenario, diverse combinations of radiopharmaceuticals (for targeting bone, cancer cells and receptors) and nuclear medicine modalities (e.g. bone scan, SPECT, SPECT/CT, PET and PET/CT) are now available for imaging bone metastases. Some radiopharmaceuticals are approved, currently available and used in the routine clinical setting, while others are not registered and are still under evaluation, and should therefore be considered experimental. On the other hand, radiologists have other tools, in addition to CT, that can better visualize bone localization and medullary involvement, such as multimodal MRI. In this review, the authors provide an overview of current management of advanced PC and discuss the choice of diagnostic modality for the detection of metastatic skeletal lesions in different phases of the disease. In addition to detection of bone metastases, the evaluation of response to therapy is another critical issue, since it remains one of the most important open questions that a multidisciplinary team faces when optimizing the management of PC. The authors emphasize the role of nuclear modalities that can presently be used in clinical practice, and also look at future perspectives based on relevant clinical data with novel radiopharmaceuticals.

European journal of nuclear medicine and molecular imaging. 2016 Mar 09 [Epub ahead of print]

Laura Evangelista, Francesco Bertoldo, Francesco Boccardo, Giario Conti, Ilario Menchi, Francesco Mungai, Umberto Ricardi, Emilio Bombardieri

Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy., Department of Internal Medicine, School of Medicine, University of Verona, Verona, Italy., Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy., Department of Urology, Sant' Anna Hospital, Como, Italy., Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy., Nuclear Medicine Department, Humanitas Gavazzeni, Via Gavazzeni 31, 24125, Bergamo, Italy. .