©TheCanadian Journal ofUrology™: International Supplement, April 2014
Addresscorrespondence toDr.ChaitanyaDivgi,Department
ofRadiology,ColumbiaUniversityMedicalCenter,722West
168
th
Street,NewYork,NY10032USA
Imagingapproacheswithadvancedprostate
cancer: techniquesand timing
DavidLeung,MD, SaravananKrishnamoorthy,MD, LawrenceSchwartz,MD,
ChaitanyaDivgi,MD
Department ofRadiology, ColumbiaUniversityMedicalCenter,NewYork,NewYork,USA
LEUNGD,KRISHNAMOORTHYS,SCHWARTZL,
DIVGI C. Imaging approaches with advanced
prostate cancer: techniques and timing.
Can J Urol
2014;21(Suppl 1):42-47.
Introduction:
Inconjunctionwithbiomarkers, imaging
isan important componentof thediagnosticworkupand
subsequentmanagement ofmenwith prostate cancer.
Materials andmethods:
The relevant literature was
retrieved from a search of MEDLINE with appropriate
keywords.
Results:
Osseousmetastases develop in close to 90% of
patientswithmetastaticprostatecancer, thusmakingbone
scans (singlephoton,usingTc-99m labeledphosphonates)
the mainstay of imaging in advanced prostate cancer.
Bone scans are limited by their lack of specificity and
an unclear relationship between bone scan changes and
disease progression or response to therapy.
In addition to Tc-99m bone scans, other technologies
that accurately identify of sites of active disease would
considerably aid castration resistant prostate cancer
(CRPC)management. Accordingly,metabolic imaging,
cell surface receptor targeting, and magnetic resonance
imaging (MRI) are being studied for their role in
evaluating metastatic disease. Due to the increasing
availability of advanced imagingmodalities, the optimal
modality and appropriate clinical time point for its use
remains unclear.
Conclusion:
Anumberof imagingmodalitiesarecurrently
or imminentlyavailable foruse inadvancedprostatecancer.
Futureresearchwill focusontheappropriate incorporation
of thesemodalities inprostate cancermanagement.
Key Words:
castration resistant prostate cancer,
CRPC, molecular imaging, FDG, NaF, PET, MRI,
androgen receptors
RisingPSAafterdefinitiveprimary therapy
Typically,afterdefinitivesurgicalorradiation therapy
forprimaryprostatecancer,patientsare followedwith
serialprostate-specificantigen (PSA). Arapidlyrising
PSAhasbeen found toportendapoorprognosis,
2
and
thePSAdoubling timehasbeen found tobepredictive
of positive imaging studies, typicallybone scans.
3
Bone scans, most frequently carried out using
single photon scintigraphic imaging of a bone-seeking
radiopharmaceutical –technetium-99m linked to a
Introduction
Thefocusofthisreview is imaging inadvancedprostate
cancer. Imaging to identifycancer in the intactprostate
gland is not currently a part of standard of care, and
is achieved usually by magnetic resonance imaging
(MRI).
42
