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

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Abstract

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.

About the authors

Anastasia A. Karpova

Pulmonology Scientific Research Institute

Author for correspondence.
Email: karpovaaadoc@yandex.ru
ORCID iD: 0000-0002-0251-254X
SPIN-code: 9993-5553

MD, Radiologist 

Russian Federation, Moscow

Nikolay I. Sergeev

Russian Scientific Center of Roentgenoradiology

Email: sergeevnickolay@yandex.ru
ORCID iD: 0000-0003-4147-1928
SPIN-code: 2408-6502

MD, Dr. Sci. (Medicine), Head of  Laboratory of  Roentgenoradiology of the Complex Diagnostics of Diseases and Radiotherapy department

Russian Federation, Moscow

Olga A. Borisova

Russian Scientific Center of Roentgenoradiology

Email: olga250578@yandex.ru
ORCID iD: 0009-0003-7809-0130
SPIN-code: 2416-1885

MD, Cand. Sci. (Medicine), Radiologist, Head of the Radionuclide Diagnostics Department

Russian Federation, Moscow

Pavel A. Nikitin

Pulmonology Scientific Research Institute

Email: paul2003@mail.ru
ORCID iD: 0000-0003-1809-6330
SPIN-code: 6257-2399

MD, Cand. Sci. (Medicine), head of X-ray department - radiologist

Russian Federation, Moscow

Dmitriy K. Fomin

Russian Scientific Center of Roentgenoradiology

Email: dkfomin@yandex.ru
ORCID iD: 0000-0002-7316-3519
SPIN-code: 4593-1292

MD, Dr. Sci. (Medicine), Professor of the Russian Academy of Sciences, Head of the Nuclear Medicine Clinic

Russian Federation, Moscow

Vladimir A. Solodkiy

Russian Scientific Center of Roentgenoradiology

Email: director@rncrr.ru
ORCID iD: 0000-0002-1641-6452
SPIN-code: 9556-6556

MD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences

Russian Federation, Moscow

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2. 1. a — multispiral computed tomography of the lumbar spine, sagittal section: osteoblastic foci in the bodies of the S1 and S2 vertebrae (white arrow), hemangioma in the body of the L2 vertebra (orange arrow); b - multispiral computed tomography of the thoracic spine, sagittal section: osteoblastic foci in the bodies of the thoracic vertebrae (white arrow), a mixed focus in the body of the Th12 vertebra (orange arrow).

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3. Fig. 2. a, b — magnetic resonance imaging of the pelvic organs, frontal section, T2-weighted images; c, d — magnetic resonance imaging of the pelvic organs, frontal section, T1-weighted images; dynamic observation a, c from 02.2023 and b, d 07.2023: osteoblastic foci in the pelvic bones, an increase in the size of foci during dynamic observation (white arrows).

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4. Fig. 3. a — Whole body scintigraphy after administration of 177Lu-PSMA, anterior projection; b — posterior projection from 12.2021: diffuse focal hyperfixation of a radiopharmaceutical of varying intensity - multiple PSMA—positive foci in bones; c - whole body scintigraphy after administration of 177Lu—PSMA, anterior projection; d — posterior projection from 04.2022: a decrease in the intensity of accumulation of the radio indicator in the foci, no new foci of hyperfixation of the radiopharmaceutical were reliably detected. PSMA is a prostate—specific membrane antigen.

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