Biological principles and clinical application of positron emission tomography-tracers in prostate cancer: a review

Prostate carcinoma is the most common malignancy in men and the second cause of death by cancer in the western world. Currently, prostate carcinoma's diagnosis is achieved by transrectal ultrasound-guided biopsy (gold-standard), usually requested after an elevation of prostate specific antigen (PSA) levels or an abnormal digital rectal exam or transrectal ultrasound. Nevertheless, this diagnosis sequence sometimes presents with significant limitations. Therefore, there is a need of a diagnosis modality that improves the tumor detection rates and that offers information for its accurate staging, allowing the treatment's planning and administration. Molecular imaging by the means of positron emission tomography uses radiopharmaceuticals labeled with positron-emitting radioisotopes to detect metabolic changes that might be suggestive of cancer tissue. Recently, this technique has suffered a huge dynamic development, and researchers have been working on novel radiotracers agents to improve accuracy in targeting and detecting prostate tumors. On this review, it is highlighted that the most promising positron emission tomography-tracers that will, in a near future, not only improve diagnostic abilities for prostate carcinoma but also open new possibilities for theranostic approaches to treat this malignancy at a world level. (C) 2019 Asian Pacific Prostate Society, Published by Elsevier Korea LLC.