Introduction
➤ Prostate cancer is the most common non-dermatologic cancer in men.
In 2019, it was estimated that there would be 174,650 new cases in
the United States, and in spite of advances in diagnosis and treatment,
an estimated 31,620 deaths would occur.
➤ Prostate cancer poses unique challenges:
• A distinct clinical disease state characterized by an elevated serum prostate specific
antigen (PSA) consistent with recurrent disease without findings of metastases on
historically conventional imaging studies
• Difficulty in monitoring patients with metastatic bone disease due to the poor test
characteristics of conventional bone imaging
• Increasing evidence for
▶ Local salvage therapy
▶ Metastasis-directed therapy
▶ Increasingly effective early systemic therapies
➤ The predilection for prostate cancer to metastasize to bone and lymph
nodes requires both bone and soft tissue imaging techniques.
➤ Advances in nuclear medicine and molecular imaging are poised to
reinvent the way in which we diagnose, stage and monitor response to
therapy in patients with prostate cancer.
Treatment
➤ Recommendation 1. Imaging is recommended for all patients with
advanced prostate cancer. (See Recommendations 4.1-11 for specific
details according to clinical scenario) (Strong Recommendation; EB-B-I).
➤ Recommendation 2. One or more of the following imaging modalities
should be used for patients with advanced prostate cancer:
conventional imaging (defined as computed tomography, bone scan
and/or prostate MRI), and/or next generation imaging (NGI) (PET,
PET/CT, PET/MRI, whole body MRI), according to clinical scenario
(Strong Recommendation; EB-B-I).
➤ Recommendation 3. It is recommended when choosing an imaging
modality that disease states and clinical scenarios as described
are taken into consideration, since the imaging modality may
guide treatment or change clinical treatment decisions (Strong
Recommendation; EB-B-I).
