A review of prostate cancer imaging, positron emission tomography, and radiopharmaceutical-based therapy

Imaging is essential in the detection, diagnosis, staging, and monitoring of men with prostate cancer. Over the past decade, technical advancements have led to improved sensitivity, specificity, and accuracy of disease detection. Further advances in the availability and use of radiopharmaceuticals for imaging and therapy in men with prostate cancer are starting to make their way into clinical practice. Today, in Canada, TRUS-guided biopsy of the prostate gland is still the standard of care for diagnosis, while CT and bone scan remain the standard of care to evaluate distant disease. MRI and MRI-guided biopsy is recommended in men with negative TRUS-guided biopsy and may be helpful to re-evaluate men deemed suitable for active surveillance based on PSA, TRUS, and biopsy. 223RaCl2 is recommended for reducing symptomatic skeletal events and prolonging survival in men with castrationresistant disease. Although it is likely that PET and RLT will become part of the imaging and therapy armamentarium for men with prostate cancer in the near future, the most effective algorithm is still evolving.