[Imaging modalities for primary diagnosis and staging of prostate cancer]

The new S3 guideline on prostate cancer includes imaging modalities applied for early detection, primary diagnosis, and staging of prostate cancer. Detection and primary diagnosis are based on digital rectal examination, serum PSA levels, and prostate biopsy. Among the imaging modalities, MRI shows the highest test quality parameters. Although MRI cannot replace biopsy to prove prostate cancer, its high negative predictive value can help to reduce the number of subsequent biopsies after negative prostate biopsy. For T-staging, MRI also demonstrates the highest test quality parameters. Its clinical application is limited, since therapeutic consequences are restricted. Due to its high specificity, MRI can save unnecessary pelvic lymph node dissections in patients at high risk for lymph node metastasis (N-staging). Risk-adjusted bone scans, complemented by additional radiological examinations if necessary, remain the standard to assess hematogenous metastasis (M staging).