TABLE 3. Recommendations for Future Work Directed at Challenges in Prostate Cancer Treatment and Patient Management.

Challenge	Recommendation	Imaging Methods to Develop or Improve
Diagnostic accuracy	Supplement PSA screening to increase accuracy of diagnosis, develop more sensitive serum and/or tissue biomarkers, consider cancer imaging before biopsy, move from 2D to 3D imaging and/or histopathologic validation, develop new imaging techniques that depict disease and guide tissue biopsy	Contrast-enhanced ultrasound, ultrasound spectroscopy, MRS, DWI, DCE-MRI, molecular probes with SPECT/PET, Raman spectroscopy, smart needle
Risk stratification, initial staging, active surveillance, focal therapy	Imaging-based monitoring during active surveillance (with or without other interventions such as dietary and lifestyle modifications, 5α-reductase inhibitors, complementary alternative medicines, oral antiandrogens, or chemoprevention), imaging guidance of focal therapies	MRI, MRS, SPECT or CT, CHAMPS, DCE-MRI, DWI, LNMRI, MRProstateCarea and Slicerb, MrBotc, HIFU
D0 disease	Accurately determine location and extent (local or distant) of cancer recurrence, assist in treatment planning	PET and SPECT with 11C tracers and/or rotating 3D acquisition, anti-18F-FACBC, 99mTc-MDP, 18F-NaF PET, MRI, MRI with Combidexd
Assessing response to therapy and/or role of imaging in drug development and advanced disease management	Develop technology to reliably and accurately measure antitumor effects via change in metastatic bone images, conduct clinical trials to evaluate new treatment and new agents and qualify new biomarkers	FDHT PET, FDG PET, 3D volumetric CT, fDM, 99mTc-MDP/SPECT, 18F-NaF PET, DCE-MRI, DWI, HIFU, and MR-guided HIFU

Note—PSA = prostate-specific antigen, MRS = MR spectroscopy, DWI = diffusion-weighted MRI, DCE-MRI = dynamic contrast-enhanced MRI, CHAMPS = correlated histopathology and marker placement system, LNMRI = lymphotrophic nanoparticle–enhanced MRI, HIFU = high-intensity focused ultrasound, D₀ = PSA relapse after radiation therapy or radical prostatectomy, anti-¹⁸F-FACBC = anti-1-amino-3-¹⁸F-fluorocyclobutane-1-carboxylic acid, MDP = methylene diphosphonate, ¹⁸F-NaF = ¹⁸F sodium fluoride, FDHT = ¹⁸F-fluorodihydrotestosterone, fDM = functional diffusion mapping.

^aMRProstateCare: software module manufactured by Image Guided Prostate Therapy Core.

^bSlicer surgical navigator platform is open-source software.

^cMrBot robot for imaging-guided access to the prostate manufactured by URobotics.

^dCombidex: monocrystalline iron oxide manufactured by Advanced Magnetics.