BACKGROUND: The presence of metastasis is the most important prognostic indicator in patients with prostate carcinoma and is the predominant determinant of therapeutic choices. Current tools for detection of recurrence or metastasis are less than optimal. Recent clinical trials with radiolabeled monoclonal antibodies appear to provide more precise localization of prostate cancer in these clinical circumstances. METHODS: Multicenter national trials of patients at relatively high risk for metastasis at diagnosis and patients with biochemical evidence of recurrence after prostatectomy underwent radioimmunoscintigraphy with capromab pendetide. RESULTS: Tissue confirmation of scan results demonstrated a 15-fold and 4-fold increase in sensitivity over computed tomography and magnetic resonance imaging, respectively, for newly diagnosed patients. Preliminary data have shown a 3- to 4-fold increase in durable complete response to radiation therapy in patients with biochemical failure following radical prostatectomy. CONCLUSIONS: Patients at relatively high risk for metastasis at diagnosis and those with biochemical evidence of recurrence after prostatectomy may benefit from radioimmunoscintigraphy.