Hybrid imaging - SPECT/CT and PET/CT - in staging prostate carcinoma and optimizing treatmen

Full text: The aim of the presentation is to review the application of the hybrid imaging methods in the diagnosis of prostate cancer (PC). It is the most common cancer in men with an elevated frequency in recent years. Its diagnosis is based on the palpable finding, the level of PSA, endorectal ultrasound and biopsy, if necessary. Important clinical problem is the early diagnosis of tumor recurrence after prostatectomy, radiation therapy or other treatment method and visualization of the local or distant metastases. MRI has greater possibilities for a local staging, with 78-88 % sensitivity and specificity of 88-89 % and recently endorectal MRI which has an accuracy of 97%. Using the hybrid imaging methods, such as Single photon emission tomography/ Computer tomography SPECT/CT, Positron emission tomography PET/CT, and Positron emission tomography/ Magnetic resonance imaging PET/MRI, an unique combined functional and anatomic/ morphological image of the examined organ and tumor spread is achieved. Application of SPECT/CT in PC is basically used for a visualization of bone metastases and sentinel lymph nodes. PET/CT with 18F-FDG, nowadays is not applied as a routine diagnostic method, but those developed in the recent years 18F/11C-choline and mostly 68Ga-PSMA, has become the methods of choice for visualization of both local recurrence and distant metastases. PET/MRI is a new hope, especially with 68Ga-PSMA, combining high sensitivity with specificity, including cases with PSA less than 2 ng/ml, in contrast to other imaging methods which were routinely employed. It can be said that hybrid imaging methods with the new radiopharmaceuticals for the staging and visualization of recurrences in PC are with an increased clinical use, based on high accuracy, but their place in the overall diagnostic algorithm is now being proved and a further summary of the results is expected