Prostate cancer (PCa) represents a significant source of morbidity and mortality for men in the United States, with approximately 1 in 9 being diagnosed with PCa in their lifetime. The role of imaging in the evaluation of men with PCa has evolved and currently plays a central role in diagnosis, treatment planning, and evaluation of recurrence. Appropriate use of multiparametric MRI (mpMRI) and MRI-guided transrectal ultrasound (MR-TRUS) biopsy increases the detection of clinically significant PCa while decreasing the detection of clinically insignificant PCa. This process may help patients with clinically insignificant PCa avoid the adverse effects of unnecessary therapy. In the setting of a known PCa, patients with low-grade disease can be observed using active surveillance, which often includes a combination of prostate-specific antigen (PSA) testing, serial mpMRI, and, if indicated, follow-up systematic and targeted TRUS-guided tissue sampling. mpMRI can provide important information in the posttreatment setting, but PET/CT is creating a paradigm shift in imaging standards for patients with locally recurrent and metastatic PCa. This article examines the strengths and limitations of mpMRI for initial PCa diagnosis, active surveillance, recurrent disease evaluation, and image-guided biopsies, and the use of PET/CT imaging in men with recurrent PCa. The goal of this review is to provide a rational basis for current NCCN Clinical Practice Guidelines in Oncology for PCa as they pertain to the use of these advanced imaging modalities.
Brandon R. Mason, James A. Eastham, Brian J. Davis, Lance A. Mynderse, Thomas J. Pugh, Richard J. Lee and Joseph E. Ippolito
James L. Mohler, Emmanuel S. Antonarakis, Andrew J. Armstrong, Anthony V. D’Amico, Brian J. Davis, Tanya Dorff, James A. Eastham, Charles A. Enke, Thomas A. Farrington, Celestia S. Higano, Eric Mark Horwitz, Michael Hurwitz, Joseph E. Ippolito, Christopher J. Kane, Michael R. Kuettel, Joshua M. Lang, Jesse McKenney, George Netto, David F. Penson, Elizabeth R. Plimack, Julio M. Pow-Sang, Thomas J. Pugh, Sylvia Richey, Mack Roach III, Stan Rosenfeld, Edward Schaeffer, Ahmad Shabsigh, Eric J. Small, Daniel E. Spratt, Sandy Srinivas, Jonathan Tward, Dorothy A. Shead and Deborah A. Freedman-Cass
The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.