Imaging clinically localized prostate cancer

For men residing within the United States, prostate cancer is second only to lung cancer in cancer mortality and second in incidence to nonmelanomatous skin cancers. The introduction in the 1980s of prostate-specific antigen (PSA) as a part of cancer screening protocols increased detection of clinically significant (and insignificant) prostate cancer, which has led to earlier identification of prostate cancer, at more treatable stages. Given the substantial stage migration that has occurred, prostate cancer is rarely a systemically detectable disease at presentation. Therefore, clinicians have gone from using imaging-based staging to using clinical variables in combination (ie, serum PSA, T stage, Gleason score, and extent of disease on biopsy) as a more efficient means of assessing the likely extent of disease and the best initial treatment. Thus, there is significant controversy with regard to the optimal treatment of prostate cancer and the role of imaging in staging prostate cancer. This article explores the current literature with regard to the accuracy and utility of transrectal ultrasound (TRUS), modifications of TRUS, NM and magnetic resonance spectroscopy, radiolabeled antibody imaging (ProstaScint), and CT in staging clinically localized prostate cancer.