Finally, it is important to recognize that the clinical scenarios here still represent broad ranges of risk for recurrence or metastases in individuals with prostates. For example, in Variant 1, clinically appropriate imaging may be different for a patient with initially detected BCR and a PSA <1 ng/mL, versus a PSA >40 ng/mL, or for a patient with persistently detectable PSA after surgery. We chose to avoid challenging subcategorizations of many individual patient scenarios encountered in clinical practice, such as by specific PSA ranges or PSA kinetics, or other clinical parameters. It is important to note that in general the yield of the various imaging studies can be related to these additional specific clinical risk parameters. Finally, it should be noted that this document includes analysis of imaging techniques that are formally approved by the FDA. Special Imaging Considerations TRUS Prostatectomy Bed: Drudi et al [19] showed contrast-enhanced color Doppler transrectal US (TRUS) performed as well as contrast-enhanced MRI in detecting local recurrence after prostatectomy; however, intravascular microbubble contrast agents are not FDA approved for this application. Discussion of Procedures by Variant Variant 1: Prostate cancer follow-up. Status post radical prostatectomy. Clinical concern for residual or recurrent disease. Following RP, serum PSA levels are expected to be undetectable within several weeks of surgery. Waiting 6 to 8 weeks after treatment is advisable before assessing the serum PSA value because the half-life of serum PSA is CT Abdomen and Pelvis CT is not effective for detecting recurrent tumors in the surgical bed. The mean PSA value associated with a positive CT scan after RP was 27.4 ng/mL, and this typically represents very large recurrent masses (>2 cm in size) [7].
Post Treatment Follow up of Prostate Cancer. Finally, it is important to recognize that the clinical scenarios here still represent broad ranges of risk for recurrence or metastases in individuals with prostates. For example, in Variant 1, clinically appropriate imaging may be different for a patient with initially detected BCR and a PSA <1 ng/mL, versus a PSA >40 ng/mL, or for a patient with persistently detectable PSA after surgery. We chose to avoid challenging subcategorizations of many individual patient scenarios encountered in clinical practice, such as by specific PSA ranges or PSA kinetics, or other clinical parameters. It is important to note that in general the yield of the various imaging studies can be related to these additional specific clinical risk parameters. Finally, it should be noted that this document includes analysis of imaging techniques that are formally approved by the FDA. Special Imaging Considerations TRUS Prostatectomy Bed: Drudi et al [19] showed contrast-enhanced color Doppler transrectal US (TRUS) performed as well as contrast-enhanced MRI in detecting local recurrence after prostatectomy; however, intravascular microbubble contrast agents are not FDA approved for this application. Discussion of Procedures by Variant Variant 1: Prostate cancer follow-up. Status post radical prostatectomy. Clinical concern for residual or recurrent disease. Following RP, serum PSA levels are expected to be undetectable within several weeks of surgery. Waiting 6 to 8 weeks after treatment is advisable before assessing the serum PSA value because the half-life of serum PSA is CT Abdomen and Pelvis CT is not effective for detecting recurrent tumors in the surgical bed. The mean PSA value associated with a positive CT scan after RP was 27.4 ng/mL, and this typically represents very large recurrent masses (>2 cm in size) [7].