Imaging of prostate cancer

Prostate cancer diagnosis and treatment is fast emerging as a major health care issue in the United States. However, there are great uncertainties about the value of specific tests and therapies. Imaging modalities play a major role in the current management of patients with prostate cancer and this role is likely to expand in the future. Transrectal ultrasound is used to identify nonpalpable lesions, direct systematic biopsies, determine gland volume and stage prostate cancers. For staging skeletal metastases, the bone scan is acknowledged as the best method, however controversy surrounds its routine use in patients with low prostate specific antigen (PSA) values. Computed tomography (CT) and transrectal ultrasound have limited value in detecting extracapsular disease but CT can be used in conjunction with percutaneous biopsy to identify nodal metastases. The role of Endorectal coil MRI is currently evolving in the wake of a disappointing multi-institutional trial but MRI still holds the most promise for accurately detecting local extent of prostate cancer. New radiolabeled techniques with monoclonal antibodies and peptide imaging are also having early but promising results. The role of imaging in prostate cancer is continuing to evolve as technology and knowledge about prostate cancer biology improves and health care economics force a more judicious use of imaging resources.