Purpose This prospective study was aimed at assessing the ability of 99m Tc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99m Tc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. Patients and Methods Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. Results Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99m Tc-PSMA detected 52 of the 55 bone lesions detected on 99m Tc-MDP. However, 99m Tc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177 Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99m Tc-MDP and none on 99m Tc-PSMA. Conclusions 99m Tc-PSMA was comparable to 99m Tc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99m Tc-PSMA may be a better alternative to 99m Tc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

Ovarian carcinoma remains an important cause of mortality and morbidity, which tends to be diagnosed at an advanced stage due to the non-specific and generalized nature of the symptoms.In this chapter, we review the clinical significance of ovarian cancer, its current diagnosis and treatment and the evolving role of nuclear medicine in the early, non-invasive detection and further management of these patients. We also consider some of the current and future theranostic possibilities in the quest for targeted treatment with fewer systemic side effects.

Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer worldwide, with an estimated 2.3 million new cases (11.7%), followed by lung cancer (11.4%) The current literature and the National Comprehensive Cancer Network (NCCN) guidelines state that 18F-FDG PET/CT is not routine for early diagnosis of breast cancer, and rather PET/CT scanning should be performed for patients with stage III disease or when conventional staging studies yield non-diagnostic or suspicious results because this modality has been shown to upstage patients compared to conventional imaging and thus has an impact on disease management and prognosis. Furthermore, with the growing interest in precision therapy in breast cancer, numerous novel radiopharmaceuticals have been developed that target tumor biology and have the potential to non-invasively guide the most appropriate targeted therapy. This review discusses the role of 18F-FDG PET and other PET tracers beyond FDG in breast cancer imaging.

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