In the evaluation of nodal disease, CT heavily relies on size to detect nodal metastases, which is a significant limitation and confers mediocre 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 the diagnosis and follow-up of bone metastases [27], and choline PET is much better for the detection and follow-up of bone metastases. As bone metastases respond to treatment, they often become more densely sclerotic, which by CT is a common pitfall falsely interpreted as progression. CT is useful when done with 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 after nonsurgical local and pelvic treatments. Additionally, there is limited evidence to support the use CT chest abdomen and pelvis in this setting. MRI Pelvis MP-MRI has shown to be helpful in the detection of local recurrence after RT, and T2-weighted imaging by itself is very limited for detection of recurrence after RT [29]. Wu et al [39] in a meta-analysis to assess the effectiveness of an MP-MRI in detecting local recurrent prostate cancer post-RT found that DCE imaging, As with Variant 1, typically in this setting, MRI is performed on 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.
Post Treatment Follow up of Prostate Cancer. In the evaluation of nodal disease, CT heavily relies on size to detect nodal metastases, which is a significant limitation and confers mediocre 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 the diagnosis and follow-up of bone metastases [27], and choline PET is much better for the detection and follow-up of bone metastases. As bone metastases respond to treatment, they often become more densely sclerotic, which by CT is a common pitfall falsely interpreted as progression. CT is useful when done with 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 after nonsurgical local and pelvic treatments. Additionally, there is limited evidence to support the use CT chest abdomen and pelvis in this setting. MRI Pelvis MP-MRI has shown to be helpful in the detection of local recurrence after RT, and T2-weighted imaging by itself is very limited for detection of recurrence after RT [29]. Wu et al [39] in a meta-analysis to assess the effectiveness of an MP-MRI in detecting local recurrent prostate cancer post-RT found that DCE imaging, As with Variant 1, typically in this setting, MRI is performed on 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.