Overall, pelvic MRI in the setting of Variant 2 is complementary to specialized PET examinations (choline, PSMA, or fluciclovine), and both categories of examinations may be beneficial to perform. MRI Abdomen and Pelvis MRI is performed of the pelvis only, at least initially. Residual, recurrent, or metastatic disease is all most likely to be identified in the pelvis, and additional coverage of the abdomen is of little added value. Additionally, there is limited evidence to support the use of MRI abdomen and pelvis for follow-up of a patient with a clinical concern for residual or recurrent disease after nonsurgical local and pelvic treatments. TRUS Prostate Several studies have reported that TRUS is unreliable for the detection of cancer recurrence after EBRT, showing a limited sensitivity of 49% and a specificity of 57%, which is worse than DRE (sensitivity 73%, specificity 66%) [93,121]. TRUS-Guided Biopsy Prostate TRUS-guided sextant biopsy, commonly proposed as the reference standard for detection of local recurrence, may require repeated biopsies to reach a final diagnosis [122,123]. In addition to false-negative results due to sampling error, false-positive results may also occur because the presence of malignant cells in biopsy specimens may represent biologically inactive tumor remnants, especially in the first 1 to 2 years after RT [122,123]. Post-Treatment Follow-up of Prostate Cancer MRI-Targeted Biopsy Prostate Biopsy is best done when targeting suspicious lesions identified by MRI rather than as a nontargeted systematic TRUS biopsy of the region. However, because the native gland is still present, commercially available MRI-US fusion biopsy systems can be used to aid in targeting and improving biopsy accuracy. Candidacy for salvage local therapy is largely determined by identification and characterization of a treatable local recurrence by biopsy, often targeted by MRI.
Post Treatment Follow up of Prostate Cancer. Overall, pelvic MRI in the setting of Variant 2 is complementary to specialized PET examinations (choline, PSMA, or fluciclovine), and both categories of examinations may be beneficial to perform. MRI Abdomen and Pelvis MRI is performed of the pelvis only, at least initially. Residual, recurrent, or metastatic disease is all most likely to be identified in the pelvis, and additional coverage of the abdomen is of little added value. Additionally, there is limited evidence to support the use of MRI abdomen and pelvis for follow-up of a patient with a clinical concern for residual or recurrent disease after nonsurgical local and pelvic treatments. TRUS Prostate Several studies have reported that TRUS is unreliable for the detection of cancer recurrence after EBRT, showing a limited sensitivity of 49% and a specificity of 57%, which is worse than DRE (sensitivity 73%, specificity 66%) [93,121]. TRUS-Guided Biopsy Prostate TRUS-guided sextant biopsy, commonly proposed as the reference standard for detection of local recurrence, may require repeated biopsies to reach a final diagnosis [122,123]. In addition to false-negative results due to sampling error, false-positive results may also occur because the presence of malignant cells in biopsy specimens may represent biologically inactive tumor remnants, especially in the first 1 to 2 years after RT [122,123]. Post-Treatment Follow-up of Prostate Cancer MRI-Targeted Biopsy Prostate Biopsy is best done when targeting suspicious lesions identified by MRI rather than as a nontargeted systematic TRUS biopsy of the region. However, because the native gland is still present, commercially available MRI-US fusion biopsy systems can be used to aid in targeting and improving biopsy accuracy. Candidacy for salvage local therapy is largely determined by identification and characterization of a treatable local recurrence by biopsy, often targeted by MRI.