Recurrences can be accurately identified very early in BCR at the time of initial laboratory diagnosis of BCR when the PSA is still well under 1 ng/mL [10]. Although most local recurrences are perianastomotic, retrovesical, or in the seminal vesicle bed, 30% may be elsewhere in the pelvis at sites that can be more readily assessed by MRI than by US [32]. MP-MRI studies for detecting local recurrence after prostatectomy have reported 84% to 100% sensitivity and 89% to 97% specificity [6,10,33]. Typically, in this setting, MRI of the pelvis only is performed, at least initially. Residual, recurrent, or metastatic disease are all most likely to be identified in the pelvis, and additional coverage of the abdomen is of little added value. Post-Treatment Follow-up of Prostate Cancer The accuracy of MRI for staging pelvic lymph nodes, similar to CT, is largely reliant on size criteria and is only minimally better than that of CT. MRI is more sensitive and specific in the diagnosis of bone metastases, with a much better spatial and contrast resolution when compared to scintigraphic bone scan [34,35]. Gutzeit et al [36] reported the use of whole body diffusion-weighted imaging (DWI)-MRI in 36 patients with 45 skeletal metastases from breast cancer and prostate cancer and concluded that markedly more metastases could be discovered using the whole body DWI technique than skeletal scintigraphy. Response of bone metastases to treatment can be more accurately monitored by serial MRI scans [37]. MRI has a similar performance in bone metastasis detection as choline PET [8]. Overall, pelvic MRI in the setting of Variant 1 is complementary to specialized PET examinations (choline or fluciclovine), and both categories of examinations may be beneficial to perform.
Post Treatment Follow up of Prostate Cancer. Recurrences can be accurately identified very early in BCR at the time of initial laboratory diagnosis of BCR when the PSA is still well under 1 ng/mL [10]. Although most local recurrences are perianastomotic, retrovesical, or in the seminal vesicle bed, 30% may be elsewhere in the pelvis at sites that can be more readily assessed by MRI than by US [32]. MP-MRI studies for detecting local recurrence after prostatectomy have reported 84% to 100% sensitivity and 89% to 97% specificity [6,10,33]. Typically, in this setting, MRI of the pelvis only is performed, at least initially. Residual, recurrent, or metastatic disease are all most likely to be identified in the pelvis, and additional coverage of the abdomen is of little added value. Post-Treatment Follow-up of Prostate Cancer The accuracy of MRI for staging pelvic lymph nodes, similar to CT, is largely reliant on size criteria and is only minimally better than that of CT. MRI is more sensitive and specific in the diagnosis of bone metastases, with a much better spatial and contrast resolution when compared to scintigraphic bone scan [34,35]. Gutzeit et al [36] reported the use of whole body diffusion-weighted imaging (DWI)-MRI in 36 patients with 45 skeletal metastases from breast cancer and prostate cancer and concluded that markedly more metastases could be discovered using the whole body DWI technique than skeletal scintigraphy. Response of bone metastases to treatment can be more accurately monitored by serial MRI scans [37]. MRI has a similar performance in bone metastasis detection as choline PET [8]. Overall, pelvic MRI in the setting of Variant 1 is complementary to specialized PET examinations (choline or fluciclovine), and both categories of examinations may be beneficial to perform.