In the evaluation of nodal disease, CT relies on size to detect nodal metastases, which is a significant limitation and confers poor sensitivity for prostate cancer nodal metastases because large numbers of metastatic nodes are known to be a normal size [26]. CT is useful in following the response of known enlarged metastatic lymphadenopathy to treatment. CT is useful in detecting sclerotic bone and visceral metastases, although bone scan and MRI are superior in both the diagnosis and follow-up of bone metastases [27], and choline PET is much better for detection and follow-up of bone metastases. Because bone metastases respond to treatment, they often become more densely sclerotic, which by CT is a common pitfall that can lead to false interpretation as disease progression. CT is useful when done with intravenous (IV) contrast for cancer detection and surveillance. There is no evidence to support use of CT without IV contrast or multiphasic scanning (ie, without and with IV contrast). CT Chest, Abdomen, and Pelvis There is rarely any indication for consideration of extension of coverage with CT of the chest for follow-up of a patient with a clinical concern for residual or recurrent disease, status after RP. Additionally, there is limited evidence to support the use of CT chest abdomen pelvis in this setting. MRI Pelvis Local recurrence seems to be a common site of initial disease recurrence, and MP-MRI is the most accurate imaging method for identifying sites of local recurrence after RP [6,28-32]. It is worth noting that, unlike with the Prostate Imaging Reporting and Data System (PI-RADS) applied to pretreatment imaging, there are no consensus technical standard or interpretation criteria for MRI in the BCR setting. In general, 3.0T performs better than 1.5T, and endorectal coil use can offer an improved signal-to-noise ratio and resolution to aid in detecting small early recurrences compared to surface coils.
Post Treatment Follow up of Prostate Cancer. In the evaluation of nodal disease, CT relies on size to detect nodal metastases, which is a significant limitation and confers poor sensitivity for prostate cancer nodal metastases because large numbers of metastatic nodes are known to be a normal size [26]. CT is useful in following the response of known enlarged metastatic lymphadenopathy to treatment. CT is useful in detecting sclerotic bone and visceral metastases, although bone scan and MRI are superior in both the diagnosis and follow-up of bone metastases [27], and choline PET is much better for detection and follow-up of bone metastases. Because bone metastases respond to treatment, they often become more densely sclerotic, which by CT is a common pitfall that can lead to false interpretation as disease progression. CT is useful when done with intravenous (IV) contrast for cancer detection and surveillance. There is no evidence to support use of CT without IV contrast or multiphasic scanning (ie, without and with IV contrast). CT Chest, Abdomen, and Pelvis There is rarely any indication for consideration of extension of coverage with CT of the chest for follow-up of a patient with a clinical concern for residual or recurrent disease, status after RP. Additionally, there is limited evidence to support the use of CT chest abdomen pelvis in this setting. MRI Pelvis Local recurrence seems to be a common site of initial disease recurrence, and MP-MRI is the most accurate imaging method for identifying sites of local recurrence after RP [6,28-32]. It is worth noting that, unlike with the Prostate Imaging Reporting and Data System (PI-RADS) applied to pretreatment imaging, there are no consensus technical standard or interpretation criteria for MRI in the BCR setting. In general, 3.0T performs better than 1.5T, and endorectal coil use can offer an improved signal-to-noise ratio and resolution to aid in detecting small early recurrences compared to surface coils.