In patients with intermediate- and high-risk prostate cancer, choline PET/CT has shown to identify more nodal and distant metastatic lesions than conventional imaging [96,98-100]. For example, in a study of 48 patients, choline PET/CT showed a higher sensitivity (46.2% versus 69.2%) with an identical specificity (92.3%) for detecting nodal metastases [99]. In another multicenter study of 269 patients, choline PET/CT was shown to identify more nodal and distant metastatic lesions than conventional imaging, which led to a change in therapeutic indication in approximately 70% of patients [100]. Choline PET/MRI Skull Base to Mid-Thigh Choline PET/MRI is less commonly used than choline PET/CT but can be considered in the pretreatment assessment of prostate cancer based on the same principles that it better detects nodal and distant metastases than CT and bone scan [96,98-100]. For example, in a study of 48 patients with intermediate- and high-risk disease, choline PET/CT showed a higher sensitivity (46.2% versus 69.2%) with an identical specificity (92.3%) for detecting nodal metastases [99]. In a prospective study of 58 patients with high-risk disease, which specifically assessed choline PET/MRI, it was superior to CT and bone scan for detecting distant metastases (100% versus 63.6%, respectively) [101]. Pretreatment Detection of Prostate Cancer CT Abdomen and Pelvis With IV Contrast CT abdomen and pelvis with IV contrast for nodal staging is generally useful in high-risk patients because a priori risk of nodal disease exceeds 10% [20]. 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 because obtaining CT with both techniques does not provide additional benefit in terms of detecting nodal and distant metastases.
Pretreatment Detection Surveillance and Staging of Prostate Cancer. In patients with intermediate- and high-risk prostate cancer, choline PET/CT has shown to identify more nodal and distant metastatic lesions than conventional imaging [96,98-100]. For example, in a study of 48 patients, choline PET/CT showed a higher sensitivity (46.2% versus 69.2%) with an identical specificity (92.3%) for detecting nodal metastases [99]. In another multicenter study of 269 patients, choline PET/CT was shown to identify more nodal and distant metastatic lesions than conventional imaging, which led to a change in therapeutic indication in approximately 70% of patients [100]. Choline PET/MRI Skull Base to Mid-Thigh Choline PET/MRI is less commonly used than choline PET/CT but can be considered in the pretreatment assessment of prostate cancer based on the same principles that it better detects nodal and distant metastases than CT and bone scan [96,98-100]. For example, in a study of 48 patients with intermediate- and high-risk disease, choline PET/CT showed a higher sensitivity (46.2% versus 69.2%) with an identical specificity (92.3%) for detecting nodal metastases [99]. In a prospective study of 58 patients with high-risk disease, which specifically assessed choline PET/MRI, it was superior to CT and bone scan for detecting distant metastases (100% versus 63.6%, respectively) [101]. Pretreatment Detection of Prostate Cancer CT Abdomen and Pelvis With IV Contrast CT abdomen and pelvis with IV contrast for nodal staging is generally useful in high-risk patients because a priori risk of nodal disease exceeds 10% [20]. 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 because obtaining CT with both techniques does not provide additional benefit in terms of detecting nodal and distant metastases.