Precision Imaging of Prostate Cancer

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      Abass Alavi, MD, PhD (Hon), DSc (Hon), Editor
      PET tracers with different molecular targets and mechanisms improve the clinical management of prostate cancer. F-18 Fluciclovine, an amino acid analogue, provides a higher target-to-background signal as well as a higher specificity as compared with choline. The overexpression of gastrin-releasing peptide receptors (GRPR) in prostate cancer opens yet another radiomolecular theranostic capability, for example, in PSMA-negative metastases, using the GRPR antagonist RM-2. Ga-68 RM-2 PET imaging might further complement PSMA PET in understanding tumor biology. F-18 NaF PET represents a high-resolution imaging modality for prostate cancer, which is rather underused in the post–PSMA-PET imaging era. Indeed, further deep diving into various quantitative aspects could prove a useful supplementation to this new gold standard. F-18 FDG-PET imaging plays a decisive role in prognostication and effective personalized therapy planning, especially of a PSMA–targeted radioligand therapy.