Imaging the High-risk Prostate Cancer Patient: Current and Future Approaches to Staging

Imaging is critically important for the diagnosis, staging, and management of men with high-risk prostate cancer. Conventional imaging modalities have been employed for local and metastatic staging with limited performance. Sodium fluoride positron emission tomography is recommended when there is high suspicion of bone metastases despite a negative or indeterminate bone scan. Magnetic resonance imaging has advantages in local staging but its value depends on the extent of disease. Whole-body positron emission tomography/magnetic resonance imaging could provide both local and distant staging. None of the existing positron emission tomography agents are recommended in practice guidelines; however, among them, prostate-specific membrane antigen-based tracers seem to hold the most promise based on sensitivity and specificity.