Prostate cancer (PCa) is the most commonly diagnosed noncutaneous malignancy among Americans, with an incidence of more than 160,000 and a prevalence approaching 3 million. Each year about 30,000 American males die because of PCa, while worldwide mortality now approaches 260,000 annually. The natural history of PCa is heterogeneous, as the majority of lesions remain intraprostatic and indolent. However, nearly 30% of all tumors are rapidly progressive, metastatic, and highly resistant to treatment. As the vast majority of tumors are not clinically meaningful, the usefulness of screening and early detection is controversial. The standard diagnostic and staging methodology, transrectal ultrasonography-guided systemic biopsy, does not provide a meaningful biologic characterization of PCa, particularly when the disease has metastasized. Although functional magnetic resonance imaging is the most efficacious modality for evaluating primary PCa, its accuracy in staging regional and metastatic disease is low. Radiolabeled positron emission tomography/computed tomography (PET/CT) imaging, by contrast, offers a more reliable description of the molecular characteristics of the disease, as well as a clearer depiction of biochemical recurrence and metastases to the lymph nodes and bone. This review will explore the role of functional PET/CT and the performance of the most important tracers now in clinical and research use for the detection and characterization of primary disease, PCa recurrence following radical prostatectomy or radiation therapy, and metastases to the lymph nodes and bone.
After reading this article, the participant should be able to:
- Summarize the complexities involved in identifying, characterizing, and risk-stratifying lesions associated with primary and metastatic prostate cancer (PCa).
- Explain how functional molecular imaging, particularly positron emission tomography/computed tomography (PET/CT), generates essential information about the characteristics of tumor biology.
- Differentiate the relative advantages and disadvantages of the most important radiolabeled tracers used in PET/CT imaging of PCa.
- Summarize the role of radiolabeled PET/CT in the characterization of primary, locoregional, and advanced PCa that has invaded the lymph nodes and bone.
Categories: Computed Tomography, Nuclear Medicine