Background and Objectives: We are witnessing an era of increased clinical interest in
metastatic castration-resistant prostate cancer, both in terms of treatment and also in terms of
imaging options. This surge of interest is attributed to the recent developments in treatments for
metastatic prostate cancer that are able to confer a significant survival advantage. We are therefore,
anticipating an increase in the number of patients that we need to treat at this disease stage.
Imaging is undoubtedly crucial in monitoring disease response to treatment and progression.
Methods: We have reviewed the recent literature using the following search terms: “metastatic
prostate cancer”, “castration-resistant”, “bone metastases”, “bone scan”, “abiraterone”, “enzalutamide”.
Results: Bone scintigraphy has evolved recently with new and more sensitive tracers that can
accurately diagnose even low volume disease progression. MRI has an established role in the
diagnosis of spinal cord compression.
Conclusion: Metastatic, castration-resistant prostate cancer is a discrete and different phase of
prostate cancer with newer agents that have shown great promise in controlling the disease and
offering a survival benefit for patients. Recommendations regarding the choice of imaging, trigger
points for repeating imaging and intervals between imaging are still under development for this
phase of the disease especially for patients treated with new androgen targeted agents.