Novel imaging in prostate cancer

Imaging of prostate cancer (Pca) presents many challenges as imaging tools aim to improve cancer detection, assessment in biochemical relapse, and disease progression in advanced metastatic stages. Current imaging modalities have strengths but also weaknesses, such as the lack of ability to diagnose micrometastases, to differentiate significant from nonsignificant cancer, and to diagnose advanced disease at low prostate-specific antigen values. Some of the modalities appear promising in increasing the sensitivity and specificity rate, particularly in recurrent and advanced disease (e.g., prostate-specific membrane antigen–positron emission tomography). Others can prove valuable in delivering focal therapy for Pca. Finally, the combination of two modalities could provide improved results in the diagnosis of Pca. Despite promising results, most guidelines still recommend traditional imaging modalities, such as (99m)Tc bone scintigraphy and computed tomography, for the estimation of metastatic spread in bones and lymph nodes, and the routine use of the novel techniques is not considered. Prospective studies clarify the value of the modalities and determine their role in clinical practice.