Fluciclovine PET/MRI Skull Base to Mid-Thigh Fluciclovine PET/MRI is less commonly used than fluciclovine PET/CT but shares similar principles and can be considered in the pretreatment assessment of prostate cancer based on its ability to better detect nodal and distant metastases than CT and bone scan [102,105]. The specificity of fluciclovine PET/CT is high (0.98, 95% CI: 0.88- 1.00) [98], and in a study of 57 patients, it demonstrated a higher sensitivity for detecting nodal metastases (55.3% versus 33.3%) and was able to identify 12.3% (7/57) additional patients with distant metastasis when compared with conventional imaging (bone scan and CT) in patients with intermediate- and high-risk disease [106]. Although no specific study deals with only patients with intermediate-risk disease, it is notable that in a study of 28 patients with high-risk disease, the sensitivity and specificity of fluciclovine PET/MRI for detecting nodal metastases was 40% and 100%, respectively [105]. Also, fluciclovine PET/MRI has been shown to potentially improve characterization of the primary tumor compared with PET/CT [103]. Pretreatment Detection of Prostate Cancer MRI Abdomen and Pelvis Without and With IV Contrast The literature indicates that MRI abdomen and pelvis without and with IV contrast may be used in intermediate- risk patients for 1) nodal and distant metastasis staging in addition to 2) assessment of the local extent of primary tumor [109-112]. This can be supported by the fact that a priori risk of nodal disease (most of which are in the pelvis and some up to the retroperitoneum) exceeds 10% [20].
Pretreatment Detection Surveillance and Staging of Prostate Cancer. Fluciclovine PET/MRI Skull Base to Mid-Thigh Fluciclovine PET/MRI is less commonly used than fluciclovine PET/CT but shares similar principles and can be considered in the pretreatment assessment of prostate cancer based on its ability to better detect nodal and distant metastases than CT and bone scan [102,105]. The specificity of fluciclovine PET/CT is high (0.98, 95% CI: 0.88- 1.00) [98], and in a study of 57 patients, it demonstrated a higher sensitivity for detecting nodal metastases (55.3% versus 33.3%) and was able to identify 12.3% (7/57) additional patients with distant metastasis when compared with conventional imaging (bone scan and CT) in patients with intermediate- and high-risk disease [106]. Although no specific study deals with only patients with intermediate-risk disease, it is notable that in a study of 28 patients with high-risk disease, the sensitivity and specificity of fluciclovine PET/MRI for detecting nodal metastases was 40% and 100%, respectively [105]. Also, fluciclovine PET/MRI has been shown to potentially improve characterization of the primary tumor compared with PET/CT [103]. Pretreatment Detection of Prostate Cancer MRI Abdomen and Pelvis Without and With IV Contrast The literature indicates that MRI abdomen and pelvis without and with IV contrast may be used in intermediate- risk patients for 1) nodal and distant metastasis staging in addition to 2) assessment of the local extent of primary tumor [109-112]. This can be supported by the fact that a priori risk of nodal disease (most of which are in the pelvis and some up to the retroperitoneum) exceeds 10% [20].