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Diagnostic imaging to detect and evaluate response to therapy in bone metastases from prostate cancer: current modalities and new horizons

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Abstract

Different therapeutic options for the management of prostate cancer (PC) have been developed, and some are successful in providing crucial improvement in both survival and quality of life, especially in patients with metastatic castration-resistant PC. In this scenario, diverse combinations of radiopharmaceuticals (for targeting bone, cancer cells and receptors) and nuclear medicine modalities (e.g. bone scan, SPECT, SPECT/CT, PET and PET/CT) are now available for imaging bone metastases. Some radiopharmaceuticals are approved, currently available and used in the routine clinical setting, while others are not registered and are still under evaluation, and should therefore be considered experimental. On the other hand, radiologists have other tools, in addition to CT, that can better visualize bone localization and medullary involvement, such as multimodal MRI. In this review, the authors provide an overview of current management of advanced PC and discuss the choice of diagnostic modality for the detection of metastatic skeletal lesions in different phases of the disease. In addition to detection of bone metastases, the evaluation of response to therapy is another critical issue, since it remains one of the most important open questions that a multidisciplinary team faces when optimizing the management of PC. The authors emphasize the role of nuclear modalities that can presently be used in clinical practice, and also look at future perspectives based on relevant clinical data with novel radiopharmaceuticals.

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Acknowledgments

The authors are grateful to the following specialists who participated in the discussion of this proposal. Gianluigi Ciocia, MD, Nuclear Medicine Department, Humanitas Gavazzeni, Bergamo, Italy; Marialuisa De Rimini, MD, U.O.C. of Nuclear Medicine, A.O.R.N. Monaldi, Naples, Italy; Stefano Fanti, MD, Nuclear Medicine Department, Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy; Chiara Maria Grana, MD, Nuclear Medicine Division, Istituto Europeo di Oncologia, Milan, Italy; Lorenzo Maffioli, MD, Nuclear Medicine Department, Ospedale Civile di Legnano, Legnano (Milan), Italy; Marcello Rodari, MD, Nuclear Medicine Department, Humanitas Clinical and Research Institute, Rozzano (Milan), Italy; Rosa Sciuto, MD, Department of Nuclear Medicine, Regina Elena National Cancer Institute, Roma, Italy; Francesco Scopinaro, MD, Unit of Nuclear Medicine, Sant’Andrea Hospital, Rome, Italy, and Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy. All authors attended an editorial meeting hosted by Health Publishing & Services srl to discuss topics for inclusion. The entire project was made possible thanks to unconditional support from Bayer. Editorial assistance for the manuscript was provided by Dr. Patrick Moore, on behalf of Health Publishing & Services srl and supported by Bayer.

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Authors and Affiliations

  1. Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV – IRCCS, Padova, Italy

    Laura Evangelista

  2. Department of Internal Medicine, School of Medicine, University of Verona, Verona, Italy

    Francesco Bertoldo

  3. Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy

    Francesco Boccardo

  4. Department of Urology, Sant’ Anna Hospital, Como, Italy

    Giario Conti

  5. Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Ilario Menchi & Francesco Mungai

  6. Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy

    Umberto Ricardi

  7. Nuclear Medicine Department, Humanitas Gavazzeni, Via Gavazzeni 31, 24125, Bergamo, Italy

    Emilio Bombardieri

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  1. Laura Evangelista
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Evangelista, L., Bertoldo, F., Boccardo, F. et al. Diagnostic imaging to detect and evaluate response to therapy in bone metastases from prostate cancer: current modalities and new horizons. Eur J Nucl Med Mol Imaging 43, 1546–1562 (2016). https://doi.org/10.1007/s00259-016-3350-4

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