CT Chest, Abdomen, and Pelvis Without and With IV Contrast There is limited evidence to support the use of CT chest, 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. CT Chest, Abdomen, and Pelvis Without IV Contrast CT chest, abdomen, and pelvis without IV contrast for nodal staging is generally useful in intermediate-risk patients because the a priori risk of nodal disease exceeds 10% [20]. However, it should be recognized that without using IV contrast there is a possibility of less optimal detection of metastases to visceral organs. FDG-PET/CT Whole Body Because prostate cancer and metastases from it are generally not FDG-avid unlike most other malignancies, FDG- PET/CT may not be beneficial as part of staging clinically established intermediate-risk prostate cancer. FDG-PET/MRI Skull Base to Mid-Thigh Because prostate cancer and metastases from it are generally not FDG-avid unlike most other malignancies, FDG- PET/MRI may not be beneficial as part of staging clinically established intermediate-risk prostate cancer. Fluciclovine PET/CT Skull Base to Mid-Thigh Although fluciclovine PET/CT is primarily used in the recurrent setting, it can also be considered in the pretreatment assessment of prostate cancer based on its ability to better detect nodal and distant metastases than CT and bone scan [98,102-105]. The specificity of fluciclovine PET/CT is high (0.98, 95% CI: 0.88-1.00) [98], and in a study of 57 patients, it demonstrated higher sensitivity for detecting nodal metastases (55.3% versus 33.3%) and was able to identify 12.3% (7/57) additional patients with distant metastasis when compared to conventional imaging (bone scan and CT) in patients with intermediate- and high-risk disease [106].
Pretreatment Detection Surveillance and Staging of Prostate Cancer. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There is limited evidence to support the use of CT chest, 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. CT Chest, Abdomen, and Pelvis Without IV Contrast CT chest, abdomen, and pelvis without IV contrast for nodal staging is generally useful in intermediate-risk patients because the a priori risk of nodal disease exceeds 10% [20]. However, it should be recognized that without using IV contrast there is a possibility of less optimal detection of metastases to visceral organs. FDG-PET/CT Whole Body Because prostate cancer and metastases from it are generally not FDG-avid unlike most other malignancies, FDG- PET/CT may not be beneficial as part of staging clinically established intermediate-risk prostate cancer. FDG-PET/MRI Skull Base to Mid-Thigh Because prostate cancer and metastases from it are generally not FDG-avid unlike most other malignancies, FDG- PET/MRI may not be beneficial as part of staging clinically established intermediate-risk prostate cancer. Fluciclovine PET/CT Skull Base to Mid-Thigh Although fluciclovine PET/CT is primarily used in the recurrent setting, it can also be considered in the pretreatment assessment of prostate cancer based on its ability to better detect nodal and distant metastases than CT and bone scan [98,102-105]. The specificity of fluciclovine PET/CT is high (0.98, 95% CI: 0.88-1.00) [98], and in a study of 57 patients, it demonstrated higher sensitivity for detecting nodal metastases (55.3% versus 33.3%) and was able to identify 12.3% (7/57) additional patients with distant metastasis when compared to conventional imaging (bone scan and CT) in patients with intermediate- and high-risk disease [106].