DWI is helpful for detection of nodal and bone metastases and can be performed as a whole body screening examination [40]. However, the restricted diffusion at DWI can be nonspecific and can also be observed in normal sized or hyperplastic benign lymph nodes. MRI Abdomen and Pelvis 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. Additionally, there is limited evidence to support the use of MRI abdomen and pelvis for follow-up of a patient with a clinical concern for residual or recurrent disease, status post-RP. TRUS-Guided Biopsy Prostatectomy Bed TRUS-guided biopsy can be performed in a systematic manner, often done as a random sampling of the areas that most likely harbor recurrence: the vesicourethral anastomosis, retrovesical region, and seminal vesicle beds. Negative results of TRUS-guided biopsy, regardless of a palpable mass or indurations, may be inconclusive because of sampling errors. Deliveliotis et al [41] reported negative predictive values of only 67% with TRUS- guided biopsy and 57% with digital rectal examination (DRE)-guided biopsy in patients with PSA >2 ng/mL and negative imaging for metastases after prostatectomy. The yield for detecting local recurrent tumor with TRUS with needle biopsy rises significantly with serum PSA levels [41]. Only about 25% of patients with prostatectomy PSA levels of <1 ng/mL have a histologic confirmation of local recurrence after systematic biopsy of the prostatic fossa, compared with 53% of patients with prostatectomy PSA levels >2 ng/mL [41].
Post Treatment Follow up of Prostate Cancer. DWI is helpful for detection of nodal and bone metastases and can be performed as a whole body screening examination [40]. However, the restricted diffusion at DWI can be nonspecific and can also be observed in normal sized or hyperplastic benign lymph nodes. MRI Abdomen and Pelvis 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. Additionally, there is limited evidence to support the use of MRI abdomen and pelvis for follow-up of a patient with a clinical concern for residual or recurrent disease, status post-RP. TRUS-Guided Biopsy Prostatectomy Bed TRUS-guided biopsy can be performed in a systematic manner, often done as a random sampling of the areas that most likely harbor recurrence: the vesicourethral anastomosis, retrovesical region, and seminal vesicle beds. Negative results of TRUS-guided biopsy, regardless of a palpable mass or indurations, may be inconclusive because of sampling errors. Deliveliotis et al [41] reported negative predictive values of only 67% with TRUS- guided biopsy and 57% with digital rectal examination (DRE)-guided biopsy in patients with PSA >2 ng/mL and negative imaging for metastases after prostatectomy. The yield for detecting local recurrent tumor with TRUS with needle biopsy rises significantly with serum PSA levels [41]. Only about 25% of patients with prostatectomy PSA levels of <1 ng/mL have a histologic confirmation of local recurrence after systematic biopsy of the prostatic fossa, compared with 53% of patients with prostatectomy PSA levels >2 ng/mL [41].