Advances in the imaging of the prostate in the setting of elevated PSA levels.

Abstract

Mirroring exciting advances in the treatment of prostate cancer, advanced imaging techniques are providing improved detection and staging of this disease. Whereas treatment decisions were previously often made on the basis of probability, more sensitive and specific localisation of disease sites will allow choices that are better tailored to an individual patient’s disease. Multi-parametric MRI and PET/CT, particularly using ligands of the prostate specific membrane antigen receptor provide improved assessment of the prostate and, in the post-treatment setting, prostate bed and of nodal and distant metastatic disease both prior to definitive treatment of high-risk cases and at PSA failure following definitive treatment of the prostate. PET/CT may also help to select patients for targeted therapies based on prostate specific membrane antigen receptor expression, including emerging radionuclide therapy approaches. As well as localising disease sites, molecular imaging also provides opportunities to better characterise and predict biological behaviour and therapeutic response than current imaging techniques. However, despite great enthusiasm and rapid adoption of these techniques in clinical practice, there is a pressing need to better define their role in selecting, planning and monitoring treatment through further, well designed and validated studies.