Omitting dynamic contrast-enhanced imaging additionally offers benefits of decreasing study time. Nevertheless, biparametric MRI is not yet widely adopted, and it is recommended that when performed, several requirements need to be met, such as good image quality (especially diffusion-weighted imaging), potential radiologist monitoring, and a safety net for missing significant cancers (eg, PSA follow-up). MRI Whole Body Without and With IV Contrast There is limited evidence to support the use of MRI whole body without and with IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. MRI Whole Body Without IV Contrast There is limited evidence to support the use of MRI whole body without IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. PSMA PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of prostate-specific membrane antigen (PSMA) PET/CT (or PET/MRI) for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. TRUS Prostate In North America, TRUS is generally performed by urologists for purposes of localizing the prostate gland (not the cancer) prior to systematic biopsy. Conventional grayscale TRUS is not widely used for localizing the tumor, first because lesions (usually hypoechoic in appearance) are visible only in a small proportion (11%-35%) of patients [65]. In a study of 142 patients, grayscale TRUS was able to detect only 62.2% of lesions visible on multiparametric MRI [66]. Second, only a small proportion (17%-57%) of those hypoechoic lesions are confirmed to be malignant [65]. In a study of 31,296 cores obtained from 3,912 consecutive patients undergoing TRUS with biopsy, there was no statistically significant association between the presence of a hypoechoic lesion and the detection of cancer [67].
Pretreatment Detection Surveillance and Staging of Prostate Cancer. Omitting dynamic contrast-enhanced imaging additionally offers benefits of decreasing study time. Nevertheless, biparametric MRI is not yet widely adopted, and it is recommended that when performed, several requirements need to be met, such as good image quality (especially diffusion-weighted imaging), potential radiologist monitoring, and a safety net for missing significant cancers (eg, PSA follow-up). MRI Whole Body Without and With IV Contrast There is limited evidence to support the use of MRI whole body without and with IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. MRI Whole Body Without IV Contrast There is limited evidence to support the use of MRI whole body without IV contrast for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. PSMA PET/CT Skull Base to Mid-Thigh There is limited evidence to support the use of prostate-specific membrane antigen (PSMA) PET/CT (or PET/MRI) for initial imaging of patients with clinically suspected prostate cancer and no prior biopsy. TRUS Prostate In North America, TRUS is generally performed by urologists for purposes of localizing the prostate gland (not the cancer) prior to systematic biopsy. Conventional grayscale TRUS is not widely used for localizing the tumor, first because lesions (usually hypoechoic in appearance) are visible only in a small proportion (11%-35%) of patients [65]. In a study of 142 patients, grayscale TRUS was able to detect only 62.2% of lesions visible on multiparametric MRI [66]. Second, only a small proportion (17%-57%) of those hypoechoic lesions are confirmed to be malignant [65]. In a study of 31,296 cores obtained from 3,912 consecutive patients undergoing TRUS with biopsy, there was no statistically significant association between the presence of a hypoechoic lesion and the detection of cancer [67].