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In recent years (since the advent of docetaxel-based chemotherapy), the role of adrenal scintigraphy in the evaluation of patients with progressive metastatic prostate cancer (mPC) has become increasingly relevant, because many of these patients with mPC will respond to the therapy or receive a less toxic alternative. In this paper, the current data and relevant aspects regarding the use of adrenal scintigraphy in the evaluation of patients with metastatic prostate cancer are reviewed, focusing on the quality of scintigraphy and its correlation with the response to therapy. There are three different pathways for the use of scintigraphy in patients with mPC: 1. The study of patients with mPC and suspected adrenal insufficiency or structural lesions. 2. The study of patients with mPC with no detectable adrenal metastases. 3. The scintigraphic follow-up of patients with mPC. Recently, the use of new techniques such as high-resolution, three-dimensional whole-body positron emission tomography (PET) has improved the quality of scintigraphy. The latest literature suggests that the use of PET/CT in mPC patients, with no visible adrenal metastases and no baseline radiological evidence of adrenal metastases, may be useful in the identification of patients who will benefit from the earliest intervention with adrenal axis-sparing strategies. The use of PET/CT with 18F-fluorocholine or fluorodeoxyglucose may improve the quality of response assessment in patients with mPC receiving chemotherapy. There is compelling evidence that the use of adrenal scintigraphy in patients with mPC has become a safe and effective test. In the recent years, the use of adrenal scintigraphy has advanced considerably, since the advent of
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