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 99mTc-phosphonates (99mTc-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 18F-fluoride and 11C-choline or 18F-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 11C-choline and 18F-choline and 88.6 and 90.7% for 18F-fluoride, respectively. On a patient basis, the sensitivity and specificity were 85.2 and 96.5% for 11C-choline and 18F-choline and 86.9 and 79.9% for 18F-fluoride, respectively. No significant differences were found between the sensitivity and specificity of 11C-choline or 18F-choline and 18F-fluoride. There was large inconsistency in the reported sensitivity (range 39–100%) and specificity (range 57–80%) for 99mTc-BS. The literature provides evidence for superior detection of bone metastases by both 18F-fluoride PET and 18F-choline or 11C-choline PET with or without computed tomography (CT) compared with conventional 99mTc-BS. Guidelines should include 18F-fluoride PET/CT and 11C-choline or 18F-choline PET/CT as alternatives for 99mTc-BS for the detection of bone metastases in patients with prostate cancer.