Whole body planar scintigraphic bone scans have historically been frequently performed for detecting skeletal metastases in patients with rising PSA following definitive treatment but are very unlikely to be positive until relatively late in the course of advanced metastatic disease. It was previously thought that a bone scan was quite sensitive, but PET imaging with prostate-specific agents, such as those mentioned above and more sensitive bone agents like fluoride PET, have shown detectability of many lesions before a bone scan becomes positive [11]. Because planar bone scans are rarely positive without symptoms or without relatively high PSA levels, the routine use of this imaging technique at the post-treatment stage is considered ineffective by most investigators [5,12-14] and is not recommended by the National Comprehensive Cancer Network (NCCN). MRI may be helpful in the diagnosis of bone metastasis when other examinations are conflicting, and its combined use with PET imaging can be used to determine response to hormonal treatment [1]. It is notable that prostate cancer is the second leading cause of cancer related mortalities among Americans with prostates. The majority of these patients are not dying because of initial presentation of a high-stage incurable disease. Most of the patients who die from prostate cancer had originally presented with localized disease, underwent definitive primary management with curative intent, experienced treatment failure with BCR, and then their recurrent disease progressed while on nontargeted systemic therapy to become fatal. Recent imaging advances that allow identification of limited metastatic disease early in BCR rather than once the disease has become systemically advanced may hopefully lead to targeted treatments specifically for oligometastatic disease that will impact patient outcomes [18].
Post Treatment Follow up of Prostate Cancer. Whole body planar scintigraphic bone scans have historically been frequently performed for detecting skeletal metastases in patients with rising PSA following definitive treatment but are very unlikely to be positive until relatively late in the course of advanced metastatic disease. It was previously thought that a bone scan was quite sensitive, but PET imaging with prostate-specific agents, such as those mentioned above and more sensitive bone agents like fluoride PET, have shown detectability of many lesions before a bone scan becomes positive [11]. Because planar bone scans are rarely positive without symptoms or without relatively high PSA levels, the routine use of this imaging technique at the post-treatment stage is considered ineffective by most investigators [5,12-14] and is not recommended by the National Comprehensive Cancer Network (NCCN). MRI may be helpful in the diagnosis of bone metastasis when other examinations are conflicting, and its combined use with PET imaging can be used to determine response to hormonal treatment [1]. It is notable that prostate cancer is the second leading cause of cancer related mortalities among Americans with prostates. The majority of these patients are not dying because of initial presentation of a high-stage incurable disease. Most of the patients who die from prostate cancer had originally presented with localized disease, underwent definitive primary management with curative intent, experienced treatment failure with BCR, and then their recurrent disease progressed while on nontargeted systemic therapy to become fatal. Recent imaging advances that allow identification of limited metastatic disease early in BCR rather than once the disease has become systemically advanced may hopefully lead to targeted treatments specifically for oligometastatic disease that will impact patient outcomes [18].