Although the detection of early bone metastases in men with prostate cancer remains a challenge in today's medicine, current guidelines state that bone scintigraphy with Tc-phosphonates (Tc-BS) is the most sensitive method for assessing bone metastases in these patients. In general, it is stated that bone scintigraphy has reasonable sensitivity and low specificity. The aim of this study was to present a review of the contemporary literature on the performance of F-fluoride and C-choline or F-choline and to reconsider the arguments based on which the present European and US guidelines are founded. A literature search was conducted using the Medline database. Data were taken from eligible studies and the level of evidence was scored. Data were pooled to calculate the weighted sensitivity and specificity. Thirteen studies were eligible for inclusion in this review. On a lesion basis, we found a sensitivity and specificity of 84.0 and 97.7% for C-choline and F-choline and 88.6 and 90.7% for F-fluoride, respectively. On a patient basis, the sensitivity and specificity were 85.2 and 96.5% for C-choline and F-choline and 86.9 and 79.9% for F-fluoride, respectively. No significant differences were found between the sensitivity and specificity of C-choline or F-choline and F-fluoride. There was large inconsistency in the reported sensitivity (range 39-100%) and specificity (range 57-80%) for Tc-BS. The literature provides evidence for superior detection of bone metastases by both F-fluoride PET and F-choline or C-choline PET with or without computed tomography (CT) compared with conventional Tc-BS. Guidelines should include F-fluoride PET/CT and C-choline or F-choline PET/CT as alternatives for Tc-BS for the detection of bone metastases in patients with prostate cancer.