Imaging oligometastatic prostate cancer, the nuclear physician's standpoint

By virtue of its functional approach and the good resolution of the resulting images, PET fused with CT or MRI appears to be the currently most promising imaging modality for detecting and counting cancer metastases. When the number of metastases is limited, the extension is called oligometastatic, opening the way to a targeted therapy (in particular stereotactic radiotherapy) on the few secondary lesions. This approach has been particularly developed recently in prostate cancer (PC). PET/CT imaging has great potential for the characterisation of PC as oligometastatic, on the one hand, by detecting metastases at an early stage and, on the other hand, by avoiding to apply to PCs that are in fact polymetastatic an oligometastatic-based-management that would be ineffective and would delay starting the appropriate therapy. This article illustrates this new application of PET using various PET tracers either suitable for routine PC imaging, such as sodium fluoride (F-18), fluorocholine (F-18), fluciclovine (F-18) or which have not yet been granted a MA, such as Ga-68 or F-18-labeled ligands of prostate-specific antigen. (C) 2019 Elsevier Masson SAS. All rights reserved.