Multimodality imaging in prostate cancer assessment

Prostate cancer (PCa) is considered a major challenge for the many medical disciplines that deal with it; despite the diagnostic and therapeutic improvement, it remains for male sex the most common neoplasm and one of the major causes of death. Clinical presentation is classically varied and can change in relation to the disease state. The diagnostic suspicion must trigger some evaluations by a team of specialists: both biochemical and clinical. To date, despite the galaxy of new diagnostic technologies available, the first steps are still being conducted on the track that sees a central role of serum PSA levels and digito-rectal exploration (DRE). Currently an increasingly emerging role in this field is occupied by MRI, so much so that we can speak of an MRI-targeted biopsy (MRI-TB); in fact, through various methods of use, we try to improve the quality of the samples in order to have more and more accurate biopsies focused on the disease areas. The possibility of using increasingly specific sequences such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced imaging (DCE) and MR spectctroscopy (MRS) certainly places it at the center of the diagnostic step of this phase of disease. Also from a therapeutic point of view there have been great steps forward in recent years, for both non-metastatic and metastatic disease. In both the diagnostic and therapeutic fields, alongside conventional radiological and pharmacological techniques, nuclear medicine is in a very useful position. In an increasingly targeted approach and in an increasingly “precise” medicine, radiopharmaceuticals such as Ra-223 dichloride and 177Lu-PSMA represent the new frontiers of prostate cancer treatment.