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]. In addition, because a majority of the distant metastases occur (at least in the pretreatment setting) in the axial skeleton and it is rare to harbor isolated bone metastases without simultaneously harboring metastases in the pelvic and lumbosacral vertebral bones, MRI abdomen and pelvis is usually sufficient to detect the presence of bone metastasis at the patient level [113]. MRI Abdomen and Pelvis Without IV Contrast Because the main purpose for imaging the abdomen and pelvis would be to identify nodal and distant metastases, MRI abdomen and pelvis without IV contrast is a viable option as an alternative to using IV contrast [20,109-113]. However, it should be recognized that without using IV contrast there is possibility of less optimal detection of metastases to visceral organs. MRI Pelvis Without and With IV Contrast In addition to standard local and nodal staging, multiparametric MRI may be helpful in the management of high- risk prostate cancer by identifying more extensive disease that may merit supplementary extended androgen deprivation therapy, localizing dominant disease for focal therapy, guiding surgical planning, or changing management plan from surgery to radiation [49,114,115]. MRI Pelvis Without IV Contrast In addition to standard local and nodal staging, multiparametric MRI without IV contrast may be a viable option as an alternative to using IV contrast in the management of high-risk prostate cancer [49,114,115]. Although the same principles and controversies regarding the use of IV contrast persists, many of these scenarios are less dependent on the potential advantages of IV contrast. MRI-Targeted Biopsy Prostate Most patients with high-risk disease require definitive therapy, and targeted biopsy is unlikely to significantly alter management.
Pretreatment Detection Surveillance and Staging of Prostate Cancer. 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]. In addition, because a majority of the distant metastases occur (at least in the pretreatment setting) in the axial skeleton and it is rare to harbor isolated bone metastases without simultaneously harboring metastases in the pelvic and lumbosacral vertebral bones, MRI abdomen and pelvis is usually sufficient to detect the presence of bone metastasis at the patient level [113]. MRI Abdomen and Pelvis Without IV Contrast Because the main purpose for imaging the abdomen and pelvis would be to identify nodal and distant metastases, MRI abdomen and pelvis without IV contrast is a viable option as an alternative to using IV contrast [20,109-113]. However, it should be recognized that without using IV contrast there is possibility of less optimal detection of metastases to visceral organs. MRI Pelvis Without and With IV Contrast In addition to standard local and nodal staging, multiparametric MRI may be helpful in the management of high- risk prostate cancer by identifying more extensive disease that may merit supplementary extended androgen deprivation therapy, localizing dominant disease for focal therapy, guiding surgical planning, or changing management plan from surgery to radiation [49,114,115]. MRI Pelvis Without IV Contrast In addition to standard local and nodal staging, multiparametric MRI without IV contrast may be a viable option as an alternative to using IV contrast in the management of high-risk prostate cancer [49,114,115]. Although the same principles and controversies regarding the use of IV contrast persists, many of these scenarios are less dependent on the potential advantages of IV contrast. MRI-Targeted Biopsy Prostate Most patients with high-risk disease require definitive therapy, and targeted biopsy is unlikely to significantly alter management.