18F-NaF PET/CT has established its place in the oncologic clinical routine. It has essential role in initial staging, detection of suspected first osseous metastasis, suspected progression of osseous metastasis, or treatment monitoring in prostate cancer. This chapter compares 18F-fluoride PET/CT with other imaging modalities, establishing it as superior in detecting osteoblastic metastases in prostate cancer. Additionally, the use of 18F-fluoride PET/CT as a prognostic tool is emphasized, especially for assessing the skeletal tumor burden in prostate cancer. Bone uptake of 18F-NaF reflects bone reactions to bone metastases, not to cancer itself. Therefore, positive findings with 18F-NaF PET/CT may be due to both benign and malignant bone disorders. To understand this better, double tracer studies with oncotropic (fluorocholine or 68Ga-PSMA) and osteotopic tracer 18F-NaF have been presented with illustrative patient cases. Overall, the importance of 18F-fluoride PET/CT for managing prostate cancer through precise detection and evaluation of skeletal metastases helps in better clinical decision-making and improves patient outcomes.