To illustrate the heterogeneity of advanced prostate cancer (APC) through the use of next generation imaging; To highlight the importance of false positive and false negative imaging findings and their impact in oncological imaging;

The well-described APC heterogeneity impacts the choice of novel treatments and overall outcome. Next generation imaging depicts this heterogeneity but adds complexity as the reader needs to be aware of emerging knowledge with regards to false positive and false negative findings. Prostate cancer has a propensity to spread to the bones, lymph nodes, liver, lungs, and rarely brain. Up to 62% of patients with newly diagnosed metastatic prostate cancer and more than 50% of patients with CRPC have metastatic disease confined to the skeletal system....

We have selected 3 cases to illustrate disease heterogeneity and potential modern imaging pitfalls. Case 1. 63 years old man, presenting PSA 7.9 ng/ml, mpMRI prostate T3b, Gleason 4 + 5 in 7/12 cores, bilateral, up to 60% undergoing staging examinations with a NaF PET/CT and a PSMA PET/CT. The NaF PET/CT reports two bone lesions interpreted as likely metastatic (Fig 1 a,b); PSMA PET-CT shows no uptake in the two bone lesions(Fig.1 c,d) and avid uptake in the primary prostate tumour (not shown). A...

Next generation imaging has the ability to characterize the inter-lesional heterogeneity of APC and thus has the potential to influence treatment choices and optimize patient management. However, radiologists and clinicians must be aware of the pitfalls and inherent limitations of each imaging technique as to correctly discern these from true heterogeneity.

S. Curcean; London/UK - nothing to disclose S. Yusuf; London/UK - nothing to disclose D.-M. Koh; London/UK - nothing to disclose N. Tunariu; Sutton, London/UK - nothing to disclose

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