Page 6 - The Contemporary Role of Conventional Imaging for Staging, Re-staging, and Monitoring Prostate Cancer: Impact on Management

Table 3. Summary of Recommendations: PSA Recurrence After Loco-Regional Therapies

Indication Modality

APCCC 2017 Rising PSA after RP before starting SRT • Imaging (modality not specified)
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• Independent of PSA level (44% of panel vote)
• If PSA >0.5 ng/mL (29% of panel vote)

CCO 2017 19 Upon biochemical recurrence, when local salvage therapy • Bone scan
is planned after RT • CT (thorax, abdomen, pelvis)
(Imaging is not usually appropriate when SRT is planned after RP) • mpMRI appropriate when used for targeted biopsy
Imaging may be indicated in men who have not been • Imaging specific to patient’s symptoms
evaluated through regularly scheduled visits, if the
following symptoms develop:
• Severe, progressive axioskeletal • New urinary symptoms
bone pain • Swelling of legs
• Unexplained weight loss • New bowel symptoms
• Hematuria • Fatigue

CUA-CUOG 2015 20 Newly diagnosed M0 CRPC • Bone scan
(If progression on ADT without evidence of distant metastases) • Abdopelvic CT
• If PSADT <8 mo, perform imaging every 3-6 mo • Chest x-ray
• If PSADT >12 mo, perform imaging every 6-12 mo

NCCN 2018 13 PSA persistence/recurrence after RP • Consider:
• Persistence = failure of PSA to fall to undetectable levels after RP Chest x-ray or chest CT
n
• Recurrence = undetectable PSA after RP with a subsequent Bone imaging (bone scan, F-18 NaF PET/CT
n
detectable PSA that increases on ≥2 determinations when high suspicion of bone metastases)
Abdo-pelvic CT or MRI and/or TRUS
n
C-11 choline or F-18 fluciclovine PET/CT or
n
PET/MRI (recommended due to rates of
false positivity)
PSA persistence/recurrence or positive DRE after RT and • Chest x-ray or chest CT
candidate for local therapy • Bone imaging (bone scan, F-18 NaF PET/CT
• If PSA increase by ≥2 ng/mL above nadir when high suspicion of bone metastases)
• Consider imaging if PSA is confirmed to be increasing, even • Prostate MRI
if increase above nadir is <2 ng/mL, especially if young and • TRUS biopsy
healthy • Consider:
• Candidate for local therapy Abdo-pelvic CT or MRI
n
Original clinical stage T1-T2, NX or N0 C-11 choline or F-18 fluciclovine PET/CT
n
n
Life expectancy >10 yr or PET/MRI
n
PSA now <10 ng/mL
n
PSA persistence/recurrence or positive DRE after RT and • Bone imaging (bone scan, F-18 NaF PET/CT
NOT a candidate for local therapy (see definitions above) when high suspicion of bone metastases)
RADAR Group 2014 Upon biochemical recurrence after primary treatment • Bone Scan
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• First scan when PSA 5-10 ng/mL • Abdomen/pelvis/chest CT Scan
• If first scan negative, second scan when PSA=20 ng/mL and
every doubling of PSA thereafter (based on PSA testing
every 3 mo)
M0 CRPC • Bone Scan
• First scan when PSA ≥2 ng/mL • Abdomen/pelvis/chest CT Scan
• If first scan negative, second scan when PSA=5 ng/mL and
every doubling of PSA thereafter (based on PSA testing
every 3 mo)

APCCC = Advanced Prostate Cancer Consensus Conference; CCO = Cancer Care Ontario; CUA = Canadian Urological Association; CUOG = Canadian Urologic Oncology
Group; M0 = non-metastatic; NCCN = National Comprehensive Cancer Network; RADAR = Radiographic Assessments for Detection of Advanced Recurrence; SRT = salvage
radiation therapy; TRUS = transrectal ultrasound.

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