Regarding assessment of lymph nodes, MR using ultrasmall superparamagnetic iron oxide (USPIO) has shown promise to detect even micrometastatic deposits [37,38]. Two agents, ferumoxtran-10 and ferumoxytol, have been investigated based on their lymphotropic properties, accumulating in normal but not metastatic lymph nodes after injected intravenously. In a prospective multicenter study of intermediate- and high-risk patients with prostate cancer, ferumoxtran-10 showed significantly higher sensitivity (82% versus 34%) than CT with a similar specificity (93% versus 97%) [37]. Moreover, when ferumoxtran-10-based USPIO MRI was performed in conjunction with diffusion-weighted imaging, it yielded impressive results even in normal-sized lymph nodes (sensitivities and specificities of 65%-75% and 93%-96%) [38]. Nevertheless, issues related to iron overload and potential life- threatening allergic reactions have been raised, which need to be addressed before its usage in pretreatment prostate imaging. Pretreatment Detection of Prostate Cancer Choline PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/CT for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. Choline PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/MRI for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. CT Abdomen and Pelvis With IV Contrast There is limited evidence to support the use of CT abdomen and pelvis with intravenous (IV) contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. CT Abdomen and Pelvis Without and With IV Contrast There is limited evidence to support the use of CT abdomen and pelvis without and with IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy.
Pretreatment Detection Surveillance and Staging of Prostate Cancer. Regarding assessment of lymph nodes, MR using ultrasmall superparamagnetic iron oxide (USPIO) has shown promise to detect even micrometastatic deposits [37,38]. Two agents, ferumoxtran-10 and ferumoxytol, have been investigated based on their lymphotropic properties, accumulating in normal but not metastatic lymph nodes after injected intravenously. In a prospective multicenter study of intermediate- and high-risk patients with prostate cancer, ferumoxtran-10 showed significantly higher sensitivity (82% versus 34%) than CT with a similar specificity (93% versus 97%) [37]. Moreover, when ferumoxtran-10-based USPIO MRI was performed in conjunction with diffusion-weighted imaging, it yielded impressive results even in normal-sized lymph nodes (sensitivities and specificities of 65%-75% and 93%-96%) [38]. Nevertheless, issues related to iron overload and potential life- threatening allergic reactions have been raised, which need to be addressed before its usage in pretreatment prostate imaging. Pretreatment Detection of Prostate Cancer Choline PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/CT for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. Choline PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/MRI for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. CT Abdomen and Pelvis With IV Contrast There is limited evidence to support the use of CT abdomen and pelvis with intravenous (IV) contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. CT Abdomen and Pelvis Without and With IV Contrast There is limited evidence to support the use of CT abdomen and pelvis without and with IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy.