MRI Whole Body Without and With IV Contrast The literature indicates that MRI whole body can be used to assess the nodal and distant metastatic state in patients with intermediate- and high-risk prostate cancer prior to treatment [96,108,117]. In a prospective study of 56 intermediate- and high-risk patients, whole body MRI was more accurate than bone scan and similar to choline PET/CT for detecting nodal and distant metastases [96]. In a prospective study of 36 high-risk patients, whole body MRI was concordant with PSMA PET/CT for determining nonregional nodal metastases in 72.2% and for distant metastases in 86.1% of the patients [117]. In addition to standard local, nodal, and distant metastasis staging, multiparametric MRI of the prostate may be added in the whole body MRI protocol, providing additional information to assist management of high-risk prostate cancer by identifying more extensive disease that may merit supplementary extended androgen deprivation therapy, localizing dominant disease for focal therapy, guiding surgical planning, or changing management plan from surgery to radiation [49,114,115]. MRI Whole Body Without IV Contrast Because the main purpose for imaging the whole body would be to identify nodal and distant metastases, MRI whole body without IV contrast is a viable option as an alternative to using IV contrast [49,96,108,114,115,117]. However, it should be recognized that without using IV contrast there is the possibility of less optimal detection of metastases to visceral organs. PSMA PET/CT Skull Base to Mid-Thigh PSMA PET, which can be used either with CT or MRI (PET/CT and PET/MRI, respectively) has shown its potential to detect metastatic disease in patients with high-risk prostate cancer undergoing pretreatment assessment [117,119- 121].
Pretreatment Detection Surveillance and Staging of Prostate Cancer. MRI Whole Body Without and With IV Contrast The literature indicates that MRI whole body can be used to assess the nodal and distant metastatic state in patients with intermediate- and high-risk prostate cancer prior to treatment [96,108,117]. In a prospective study of 56 intermediate- and high-risk patients, whole body MRI was more accurate than bone scan and similar to choline PET/CT for detecting nodal and distant metastases [96]. In a prospective study of 36 high-risk patients, whole body MRI was concordant with PSMA PET/CT for determining nonregional nodal metastases in 72.2% and for distant metastases in 86.1% of the patients [117]. In addition to standard local, nodal, and distant metastasis staging, multiparametric MRI of the prostate may be added in the whole body MRI protocol, providing additional information to assist management of high-risk prostate cancer by identifying more extensive disease that may merit supplementary extended androgen deprivation therapy, localizing dominant disease for focal therapy, guiding surgical planning, or changing management plan from surgery to radiation [49,114,115]. MRI Whole Body Without IV Contrast Because the main purpose for imaging the whole body would be to identify nodal and distant metastases, MRI whole body without IV contrast is a viable option as an alternative to using IV contrast [49,96,108,114,115,117]. However, it should be recognized that without using IV contrast there is the possibility of less optimal detection of metastases to visceral organs. PSMA PET/CT Skull Base to Mid-Thigh PSMA PET, which can be used either with CT or MRI (PET/CT and PET/MRI, respectively) has shown its potential to detect metastatic disease in patients with high-risk prostate cancer undergoing pretreatment assessment [117,119- 121].