title: Novel imaging techniques reshape the landscape in high-risk prostate cancers.
abstract: OBJECTIVE
  High-risk prostate cancers (PCa), that is, those with prostate-specific antigen greater than 20 ng/dl, Gleason Score of at least 8, or extraprostatic spread, are nowadays commonly treated by surgery and radiotherapy combined with a fixed period of systemic treatment. Implementing these strategies requires an exhaustive assessment of metastatic spread. This review addresses the latest development in integrated imaging techniques.
  
  
  RESULTS
  In contrast to the progress that has been made in PCa treatment, diagnostic strategies have not much evolved. Most guidelines still recognize (99m)Tc bone scintigraphy and computed tomography (CT) as cornerstone modalities to assess metastatic spread in bones and lymph nodes. Therefore, modern imaging techniques should primarily focus on these two targets. PET with various tracers, including (11)C or (18)F-choline and (18)F-sodium fluoride, and MRI with or without diffusion-weighted imaging are competing to supplant bone scan and CT scan as reference imaging techniques. This review focuses on the latest development of these techniques and analyses their potential impact in everyday urology practice.
  
  
  CONCLUSIONS
  Although certain hurdles remain, PET and whole-body MRI have the ability to supplant (99m)Tc bone scan and CT as upfront test to assess metastatic spread in high-risk PCa.
authors.affiliation: Radiology Department, Cliniques Universitaires Saint Luc, Institut de Recherche Clinique, Centre du Cancer, Université Catholique de Louvain, Brussels, Belgium. frederic.lecouvet@uclouvain.be
authors.forename: Frederic E
authors.initials: FE
authors.lastname: Lecouvet
authors.forename: Renaud
authors.initials: R
authors.lastname: Lhommel
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Pasoglou
authors.forename: Ahmed
authors.initials: A
authors.lastname: Larbi
authors.forename: François
authors.initials: F
authors.lastname: Jamar
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tombal
mesh_terms: D001859:Bone Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D019275:Radiopharmaceuticals; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen