Fluoride PET/CT Whole Body There is limited evidence to support the use of fluoride PET/CT for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. MRI Abdomen and Pelvis Without and With IV Contrast There is limited evidence to support the use of MRI abdomen and pelvis without and with IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. Pretreatment Detection of Prostate Cancer MRI Abdomen and Pelvis Without IV Contrast There is limited evidence to support the use of MRI abdomen and pelvis without IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. MRI Pelvis Without IV Contrast More recently, there has been increase in the performance of MRI pelvis without IV contrast, albeit with controversy regarding the additive benefit of IV gadolinium-based contrast media for assessing prostate cancer. Unlike diffusion-weighted imaging, which is undoubtedly an essential component of prostate MRI, there has been debate over whether dynamic contrast-enhanced imaging should be retained, used but limited to assessing the presence of early and/or contemporaneous enhancement (as in the current PI-RADS schema), or even omitted altogether [50,51]. Despite the notion that detection of prostate cancer could be improved by using dynamic contrast-enhanced imaging, owing to the fact that prostate cancer typically enhances more rapidly and washes out more quickly than benign prostatic tissue, many studies have shown that the incremental diagnostic yield is minimal [52-54]. For instance, in a meta-analysis of 20 studies (2,142 patients) performing a head-to-head comparison of biparametric and multiparametric MRI, sensitivity and specificity were similar: 0.74 (95% CI: 0.66-0.81) and 0.90 (95% CI: 0.86-0.93) for biparametric and 0.76 (95% CI: 0.69-0.82) and 0.89 (95% CI: 0.85-0.93) for multiparametric, respectively [54].
Pretreatment Detection Surveillance and Staging of Prostate Cancer. Fluoride PET/CT Whole Body There is limited evidence to support the use of fluoride PET/CT for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. MRI Abdomen and Pelvis Without and With IV Contrast There is limited evidence to support the use of MRI abdomen and pelvis without and with IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. Pretreatment Detection of Prostate Cancer MRI Abdomen and Pelvis Without IV Contrast There is limited evidence to support the use of MRI abdomen and pelvis without IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. MRI Pelvis Without IV Contrast More recently, there has been increase in the performance of MRI pelvis without IV contrast, albeit with controversy regarding the additive benefit of IV gadolinium-based contrast media for assessing prostate cancer. Unlike diffusion-weighted imaging, which is undoubtedly an essential component of prostate MRI, there has been debate over whether dynamic contrast-enhanced imaging should be retained, used but limited to assessing the presence of early and/or contemporaneous enhancement (as in the current PI-RADS schema), or even omitted altogether [50,51]. Despite the notion that detection of prostate cancer could be improved by using dynamic contrast-enhanced imaging, owing to the fact that prostate cancer typically enhances more rapidly and washes out more quickly than benign prostatic tissue, many studies have shown that the incremental diagnostic yield is minimal [52-54]. For instance, in a meta-analysis of 20 studies (2,142 patients) performing a head-to-head comparison of biparametric and multiparametric MRI, sensitivity and specificity were similar: 0.74 (95% CI: 0.66-0.81) and 0.90 (95% CI: 0.86-0.93) for biparametric and 0.76 (95% CI: 0.69-0.82) and 0.89 (95% CI: 0.85-0.93) for multiparametric, respectively [54].