Hubert Poláček, František Trudič, Daniel Evin, Ján Kliment
The basic information about a well-established nuclear medicine imaging method, still frequently indicated in prostate
cancer, is presented in the review en_article. Problematic aspects of the bone scintigraphy outcomes are explained,
i.e. impracticable image quantification, low specificity, false negativity in lytic/marrow lesions, superscan and
flare response phenomenon. The article presents the shifts in the clinical recommendations for bone scintigraphy
which result from the advance of predictive modelling studies, new generation imaging techniques and the trials of
the new treatments especially in the metastatic castration resistant stage of the disease.
The accumulation rate of the bone-seeking radiopharmaceuticals (bisphosphonates labelled with 99mTc reflects well
the biological aggressiveness of metastatic lesions, while the fraction of the affected skeleton is proportional to the
risk of severe complications and bone events. In the advanced stages of the disease, which are still common, classic
bone scintigraphy findings are usually sufficient to guide the treatment. Therefore, the bone scintigraphy does
not need to be replaced by more accurate but significantly more expensive MRI and PET/CT methods in most clinical
settings. New generation imaging methods are nowadays recommended for the localization of recurrence after
the treatments with curative intent, or to better specify the equivocal bone scintigraphy findings.