Potential use of radiation methods for diagnosing bone metastases of castration-resistant prostate cancer: a literature review

Metastatic castration resistant prostate cancer (mCRPC) is the tumor progression with the development of resistance to androgen deprivation therapy. The incidence of bone metastases in these patients reaches 90%. Radiology is widely used to diagnose mCRPC. Computed tomography (CT) and magnetic resonance imaging (MRI) are beneficial in anatomic imaging, but have some limitations in evaluating effectiveness of disease treatment. Scintigraphy is used to screen for bone metastases, but is poorly suited for assessing disease progression. Positron emission tomography (PET) combined with CT and single photon emission CT are used for early detection of local or systemic spread of prostate cancer. PET of prostate specific membrane antigen is used to predict the effectiveness of anti tumor therapy based on the absorbed dose of a radiopharmaceutical (RP). The introduction of RPs (177Lu-PSMA) opens up new perspectives for radionuclide therapy with simultaneous evaluation of its efficacy using hybrid visualization. The potential use of radiology in the diagnosis of bone metastases is of particular interest for the analysis and systematization of the data obtained and for the development of indications for radioligand therapy and the evaluation of its efficacy. Published data indicate that radiologic modalities for the diagnosis of mCRPC vary in sensitivity and specificity and have their own advantages and limitations, so these modalities should be combined. The development and improvement of methods to quantitatively assess treatment efficacy and identify prognostic markers will enable more informed selection of treatment strategies and radiopharmaceuticals, leading to improved overall survival.