Nuclear medicine (bone scan, choline and PSMA PET/CT)

Abstract

Nuclear medicine techniques such as bone scan and PET/CT play an important role in staging and restaging of patients with prostate cancer, have major impact on patient management, and can guide therapy. In this chapter, we will discuss the current status of bone scan imaging and choline PET imaging and will look closely into PSMA (prostate-specific membrane antigen) PET imaging, which has seen a very swift evolution over the last 2 years. Bone scan remains an important staging tool to detect bone metastases in patients with primary intermediate or high risk PCa, due to its high sensitivity, low price, and wide availability. The implementation of hybrid SPECT/CT systems improves the specificity of this technique and reduces the number of additional exams due to inconclusive bone scan findings. 18F-fluoride PET is more sensitive, but also lacks specificity and is not as widely available. Choline PET/CT is not recommended for primary lymph node staging but is a very useful imaging technique in patients with biochemical recurrence, guiding salvage treatments. In this setting, PSMA-based PET imaging has however shown clear superiority and a greater impact on patient management, but large homogenous patient series with histological validation are still lacking. PSMA PET imaging may also proof useful in primary lymph node staging and to guide salvage treatment or radionuclide therapy in patients with metastatic PCa.