Patterns of lymphatic metastases at recurrence of prostate cancer: CT findings

We describe the CT patterns of lymphadenopathy and visceral metastasis in 22 men with clinical features of recurrent prostate cancer. Fifteen of 22 men (68%) had lymphadenopathy with predominant retroperitoneal disease in seven cases, a feature noted particularly in men whose primary treatment had involved radical pelvic radiotherapy. A previously unreported 'pseudolymphoma' pattern of massive retroperitoneal disease with contiguous invasion of the perirenal space and adrenal glands was seen (three cases). Whilst staging examinations with CT (or MRI) at initial diagnosis of prostate cancer may be confined to the pelvis if no pelvic lymphadenopathy is found, evaluation of suspected recurrent disease requires examination of the abdomen and pelvis. CT appearances of advanced prostate cancer may mimic retroperitoneal lymphoma.