MRI Whole Body Without IV Contrast There is limited evidence to support the use of MRI whole body without IV contrast for initial imaging of patients with clinically suspected prostate cancer unless or until the presence of higher-risk disease has been established histologically. PSMA PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of PSMA PET/CT (or PET/MRI) for initial imaging of patients with clinically suspected prostate cancer unless or until the presence of higher-risk disease has been established histologically. TRUS Prostate In isolation, TRUS is inaccurate for prostate cancer detection and is not useful for this purpose [65,66]. TRUS-Guided Biopsy Prostate In patients with clinically suspected prostate cancer who have had 1 negative standard TRUS-guided systematic biopsy, a second TRUS-guided systematic biopsy will be positive in 15% to 20% of cases [73-76], and so a second repeat biopsy in this setting is reasonable. The yield from additional systematic biopsies after a second biopsy falls off rapidly, with reported positive rates of 8% to 17% for the third biopsy and 7% to 12% for the fourth [73-75,77], suggesting alternative approaches such as MRI-targeted biopsy or saturation biopsy may be more useful in this specific setting of patients with 2 or more negative TRUS-guided systematic biopsies and persistent clinical suspicion for prostate cancer. Choline PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/CT for active surveillance of patients with clinically established low-risk prostate cancer. Choline PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/MRI for active surveillance of patients with clinically established low-risk prostate cancer.
Pretreatment Detection Surveillance and Staging of Prostate Cancer. MRI Whole Body Without IV Contrast There is limited evidence to support the use of MRI whole body without IV contrast for initial imaging of patients with clinically suspected prostate cancer unless or until the presence of higher-risk disease has been established histologically. PSMA PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of PSMA PET/CT (or PET/MRI) for initial imaging of patients with clinically suspected prostate cancer unless or until the presence of higher-risk disease has been established histologically. TRUS Prostate In isolation, TRUS is inaccurate for prostate cancer detection and is not useful for this purpose [65,66]. TRUS-Guided Biopsy Prostate In patients with clinically suspected prostate cancer who have had 1 negative standard TRUS-guided systematic biopsy, a second TRUS-guided systematic biopsy will be positive in 15% to 20% of cases [73-76], and so a second repeat biopsy in this setting is reasonable. The yield from additional systematic biopsies after a second biopsy falls off rapidly, with reported positive rates of 8% to 17% for the third biopsy and 7% to 12% for the fourth [73-75,77], suggesting alternative approaches such as MRI-targeted biopsy or saturation biopsy may be more useful in this specific setting of patients with 2 or more negative TRUS-guided systematic biopsies and persistent clinical suspicion for prostate cancer. Choline PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/CT for active surveillance of patients with clinically established low-risk prostate cancer. Choline PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/MRI for active surveillance of patients with clinically established low-risk prostate cancer.