Skip to main content
SpringerLink
Log in

Local and Systemic Staging by Modern Imaging Modalities in Prostate Cancer

  • Living reference work entry
  • First Online:
Urologic Oncology

  • 106 Accesses

Abstract

The management of prostate cancer is very much depending on the disease stage before treatment. Localized or organ-confined prostate cancer will be treated differently than locally advanced prostate cancer, or prostate cancer with loco-regional extension to the pelvic lymph nodes, or metastatic prostate cancer with extension to the bone or distant lymph nodes or even viscera. The need for staging in a patient might be necessary in several clinical scenarios, such as the initial staging after new diagnosis of prostate cancer, but also at the moment of recurrence of the disease in form of biochemical recurrence or clinical recurrence, as well as at the moment of advanced or metastatic disease before or during systemic treatment.

The local staging of prostate cancer with conventional imaging is limited. The results are linked to the problem to detect minimal or microscopic extraprostatic extension or lymph node invasion with a macroscopic imaging modality.

For the staging of lymph node metastasis, molecular imaging such as choline-based imaging holds suboptimal performance, while preliminary results present in literature support a possible role of PSMA PET imaging for regional staging of prostate cancer.

When it comes to staging for distant metastasis, modern imaging such as whole-body MRI and molecular imaging using choline or PSMA as tracer or ligand do outperform conventional imaging based on bone scintigraphy and cross-sectional imaging. Of note, mpMRI is of special interest to detect local recurrence after radiotherapy for prostate cancer, when patients show biochemical recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Abuzallouf S, Dayes I, Lukka H. Baseline staging of newly diagnosed prostate cancer: a summary of the literature. J Urol. 2004;171(6 Pt 1):2122–7.

    Article  PubMed  Google Scholar 

  • Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42(2):197–209.

    Article  CAS  PubMed  Google Scholar 

  • Albisinni S, Artigas C, Aoun F, Biaou I, Grosman J, Gil T, et al. Clinical impact of 68 Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate-specific antigen after treatment with curative intent: preliminary analysis of a multidisciplinary approach. BJU Int. 2016;

    Google Scholar 

  • Beresford MJ, Gillatt D, Benson RJ, Ajithkumar T. A systematic review of the role of imaging before salvage radiotherapy for post-prostatectomy biochemical recurrence. Clin Oncol (R Coll Radiol). 2010;22(1):46–55.

    Article  CAS  Google Scholar 

  • Briganti A, Chun FK, Salonia A, Zanni G, Scattoni V, Valiquette L, et al. Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy. Eur Urol. 2006;49(6):1019–26; discussion 26–7

    Article  PubMed  Google Scholar 

  • Briganti A, Abdollah F, Nini A, Suardi N, Gallina A, Capitanio U, et al. Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol. 2012;61(6):1132–8.

    Article  PubMed  Google Scholar 

  • Brock M, von Bodman C, Sommerer F, Loppenberg B, Klein T, Deix T, et al. Comparison of real-time elastography with grey-scale ultrasonography for detection of organ-confined prostate cancer and extra capsular extension: a prospective analysis using whole mount sections after radical prostatectomy. BJU Int. 2012;108(8 Pt 2):E217–22.

    Google Scholar 

  • Bruwer G, Heyns CF, Allen FJ. Influence of local tumour stage and grade on reliability of serum prostate-specific antigen in predicting skeletal metastases in patients with adenocarcinoma of the prostate. Eur Urol. 1999;35(3):223–7.

    Article  CAS  PubMed  Google Scholar 

  • Budaus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H, et al. Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69(3):393–6.

    Article  PubMed  Google Scholar 

  • Budiharto T, Joniau S, Lerut E, Van den Bergh L, Mottaghy F, Deroose CM, et al. Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases. Eur Urol. 2011;60(1):125–30.

    Article  PubMed  Google Scholar 

  • Bundschuh RA, Wendl CM, Weirich G, Eiber M, Souvatzoglou M, Treiber U, et al. Tumour volume delineation in prostate cancer assessed by [11C]choline PET/CT: validation with surgical specimens. Eur J Nucl Med Mol Imaging. 2013;40(6):824–31.

    Article  PubMed  Google Scholar 

  • Castellucci P, Ceci F, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, et al. Early biochemical relapse after radical prostatectomy: which prostate cancer patients may benefit from a restaging 11C-choline PET/CT scan before salvage radiation therapy? J Nucl Med. 2014;55(9):1424–9.

    Article  CAS  PubMed  Google Scholar 

  • Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, et al. (68)Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging. 2015;42(8):1284–94.

    Article  PubMed  Google Scholar 

  • Chade DC, Shariat SF, Cronin AM, Savage CJ, Karnes RJ, Blute ML, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol. 2011;60(2):205–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Coen JJ, Zietman AL, Thakral H, Shipley WU. Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases. J Clin Oncol. 2002;20(15):3199–205.

    Article  PubMed  Google Scholar 

  • Daneshmand S, Ahmadi H, Huynh LN, Dobos N. Preoperative staging of invasive bladder cancer with dynamic gadolinium-enhanced magnetic resonance imaging: results from a prospective study. Urology. 2012;80(6):1313–8.

    Article  PubMed  Google Scholar 

  • Deconinck. AUA annual meeting 2014 abstract. J Urol. 2014;191(Suppl)

    Google Scholar 

  • Del Vescovo R, Frauenfelder G, Giurazza F, Piccolo CL, Cazzato RL, Grasso RF, et al. Role of whole-body diffusion-weighted MRI in detecting bone metastasis. Radiol Med. 2014;119(10):758–66.

    Article  PubMed  Google Scholar 

  • Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid (6)(8)Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56(5):668–74.

    Article  PubMed  Google Scholar 

  • Eiber M, Weirich G, Holzapfel K, Souvatzoglou M, Haller B, Rauscher I, et al. Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol. 2016;70(5):829–36.

    Article  CAS  PubMed  Google Scholar 

  • Evangelista L, Guttilla A, Zattoni F, Muzzio PC, Zattoni F. Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol. 2013;63(6):1040–8.

    Article  PubMed  Google Scholar 

  • Farsad M, Schiavina R, Castellucci P, Nanni C, Corti B, Martorana G, et al. Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. J Nucl Med. 2005;46(10):1642–9.

    CAS  PubMed  Google Scholar 

  • Fendler WP, Schmidt DF, Wenter V, Thierfelder KM, Zach C, Stief C, et al. 68Ga-PSMA PET/CT detects the location and extent of primary prostate cancer. J Nucl Med. 2016;57(11):1720–5.

    Article  CAS  PubMed  Google Scholar 

  • Fuccio C, Castellucci P, Schiavina R, Guidalotti PL, Gavaruzzi G, Montini GC, et al. Role of 11C-choline PET/CT in the re-staging of prostate cancer patients with biochemical relapse and negative results at bone scintigraphy. Eur J Radiol. 2012;81(8):e893–6.

    Article  PubMed  Google Scholar 

  • Gandaglia G, Abdollah F, Schiffmann J, Trudeau V, Shariat SF, Kim SP, et al. Distribution of metastatic sites in patients with prostate cancer: a population-based analysis. Prostate. 2014;74(2):210–6.

    Article  PubMed  Google Scholar 

  • Giannarini G, Petralia G, Thoeny HC. Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature. Eur Urol. 2012;61(2):326–40.

    Article  PubMed  Google Scholar 

  • Giovacchini G, Picchio M, Coradeschi E, Scattoni V, Bettinardi V, Cozzarini C, et al. [(11)C]choline uptake with PET/CT for the initial diagnosis of prostate cancer: relation to PSA levels, tumour stage and anti-androgenic therapy. Eur J Nucl Med Mol Imaging. 2008;35(6):1065–73.

    Article  CAS  PubMed  Google Scholar 

  • Giovacchini G, Picchio M, Briganti A, Cozzarini C, Scattoni V, Salonia A, et al. [11C]choline positron emission tomography/computerized tomography to restage prostate cancer cases with biochemical failure after radical prostatectomy and no disease evidence on conventional imaging. J Urol. 2010a;184(3):938–43.

    Article  PubMed  Google Scholar 

  • Giovacchini G, Picchio M, Scattoni V, Garcia Parra R, Briganti A, Gianolli L, et al. PSA doubling time for prediction of [(11)C]choline PET/CT findings in prostate cancer patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2010b;37(6):1106–16.

    Article  CAS  PubMed  Google Scholar 

  • Grosu AL, Weirich G, Wendl C, Prokic V, Kirste S, Geinitz H, et al. 11C-choline PET/pathology image coregistration in primary localized prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41(12):2242–8.

    Article  CAS  PubMed  Google Scholar 

  • Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.

    Article  CAS  PubMed  Google Scholar 

  • Lecouvet FE, Geukens D, Stainier A, Jamar F, Jamart J, d'Othee BJ, et al. Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: diagnostic and cost-effectiveness and comparison with current detection strategies. J Clin Oncol. 2007;25(22):3281–7.

    Article  PubMed  Google Scholar 

  • Lecouvet FE, El Mouedden J, Collette L, Coche E, Danse E, Jamar F, et al. Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Eur Urol. 2012;62(1):68–75.

    Article  PubMed  Google Scholar 

  • van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q, et al. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017;119(2):209–15.

    Article  PubMed  CAS  Google Scholar 

  • Martorana G, Schiavina R, Corti B, Farsad M, Salizzoni E, Brunocilla E, et al. 11C-choline positron emission tomography/computerized tomography for tumor localization of primary prostate cancer in comparison with 12-core biopsy. J Urol. 2006;176(3):954–60; discussion 60

    Article  CAS  PubMed  Google Scholar 

  • Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, et al. Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate Cancer. J Urol. 2016;195(5):1436–43.

    Article  PubMed  Google Scholar 

  • Messiou C, Cook G, deSouza NM. Imaging metastatic bone disease from carcinoma of the prostate. Br J Cancer. 2009;101(8):1225–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mitchell CR, Lowe VJ, Rangel LJ, Hung JC, Kwon ED, Karnes RJ. Operational characteristics of (11)c-choline positron emission tomography/computerized tomography for prostate cancer with biochemical recurrence after initial treatment. J Urol. 2013;189(4):1308–13.

    Article  PubMed  Google Scholar 

  • Morigi JJ, Stricker PD, van Leeuwen PJ, Tang R, Ho B, Nguyen Q, et al. Prospective comparison of 18F-Fluoromethylcholine versus 68Ga-PSMA PET/CT in prostate Cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy. J Nucl Med. 2015;56(8):1185–90.

    Article  CAS  PubMed  Google Scholar 

  • Mottet N, Bellmunt J, Briers E, van den Bergh RCN, Bolla M, van Casteren NJ, Cornford P, Culine S, Joniau S, Lam T, Mason MD, Matveev V, van der Poel H, van der Kwast TH, Rouvière O, Wiegel T. Guidelines on prostate cancer. Eur Assoc Urol. n.d.. Web site https://uroweb.org/guideline/prostate-cancer/. Accessed 17 May 2016.

  • Oesterling JE, Martin SK, Bergstralh EJ, Lowe FC. The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer. JAMA. 1993;269(1):57–60.

    Article  CAS  PubMed  Google Scholar 

  • Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, et al. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol. 2004;171(5):1844–9; discussion 9

    Article  PubMed  Google Scholar 

  • Passoni NM, Suardi N, Abdollah F, Picchio M, Giovacchini G, Messa C, et al. Utility of [11C]choline PET/CT in guiding lesion-targeted salvage therapies in patients with prostate cancer recurrence localized to a single lymph node at imaging: results from a pathologically validated series. Urol Oncol. 2014;32(1):38 e9–16.

    Article  Google Scholar 

  • Pfister D, Porres D, Heidenreich A, Heidegger I, Knuechel R, Steib F, et al. Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with (68)Ga-PSMA-HBED-CC than with (18)F-Fluoroethylcholine PET/CT. Eur J Nucl Med Mol Imaging. 2016;43(8):1410–7.

    Article  PubMed  Google Scholar 

  • Pound CR, Partin AW. What does prostate-specific antigen recurrence mean? Curr Urol Rep. 2000;1(1):28–35.

    Article  CAS  PubMed  Google Scholar 

  • Rahim F, Hajizamani S, Mortaz E, Ahmadzadeh A, Shahjahani M, Shahrabi S, et al. Molecular regulation of bone marrow metastasis in prostate and breast cancer. Bone Marrow Res. 2014;2014:405920.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Rauscher I, Maurer T, Beer AJ, Graner FP, Haller B, Weirich G, et al. Value of 68Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. J Nucl Med. 2016;57(11):1713–9.

    Article  CAS  PubMed  Google Scholar 

  • de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol. 2016;70(2):233–45.

    Article  PubMed  Google Scholar 

  • Rybalov M, Breeuwsma AJ, Leliveld AM, Pruim J, Dierckx RA, de Jong IJ. Impact of total PSA, PSA doubling time and PSA velocity on detection rates of 11C-choline positron emission tomography in recurrent prostate cancer. World J Urol. 2013;31(2):319–23.

    Article  CAS  PubMed  Google Scholar 

  • Shen G, Deng H, Hu S, Jia Z. Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skelet Radiol. 2014;43(11):1503–13.

    Article  Google Scholar 

  • Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25(15):2035–41.

    Article  PubMed  PubMed Central  Google Scholar 

  • Steuber T, Graefen M, Haese A, Erbersdobler A, Chun FK, Schlom T, et al. Validation of a nomogram for prediction of side specific extracapsular extension at radical prostatectomy. J Urol. 2006;175(3 Pt 1):939–44; discussion 44

    Article  PubMed  Google Scholar 

  • Suardi N, Gandaglia G, Gallina A, Di Trapani E, Scattoni V, Vizziello D, et al. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol. 2015;67(2):299–309.

    Article  PubMed  Google Scholar 

  • Ukimura O, Troncoso P, Ramirez EI, Babaian RJ. Prostate cancer staging: correlation between ultrasound determined tumor contact length and pathologically confirmed extraprostatic extension. J Urol. 1998;159(4):1251–9.

    Article  CAS  PubMed  Google Scholar 

  • Van den Bergh L, Koole M, Isebaert S, Joniau S, Deroose CM, Oyen R, et al. Is there an additional value of (1)(1)C-choline PET-CT to T2-weighted MRI images in the localization of intraprostatic tumor nodules? Int J Radiat Oncol Biol Phys. 2012;83(5):1486–92.

    Article  PubMed  Google Scholar 

  • Wu LM, Xu JR, Gu HY, Hua J, Zhu J, Chen J, et al. Role of magnetic resonance imaging in the detection of local prostate cancer recurrence after external beam radiotherapy and radical prostatectomy. Clin Oncol (R Coll Radiol). 2013;25(4):252–64.

    Article  CAS  Google Scholar 

  • Zamboglou C, Drendel V, Jilg CA, Rischke HC, Beck TI, Schultze-Seemann W, et al. Comparison of 68Ga-HBED-CC PSMA-PET/CT and multiparametric MRI for gross tumour volume detection in patients with primary prostate cancer based on slice by slice comparison with histopathology. Theranostics. 2017;7(1):228–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Francesco Ceci & Stefano Fanti

  2. Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France

    Jochen Walz

Authors
  1. Francesco Ceci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefano Fanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jochen Walz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jochen Walz .

Editor information

Editors and Affiliations

  1. Urologie, Univ Lübeck, Lübeck, Schleswig-Holstein, Germany

    Axel Merseburger

  2. Dept. of Urology, University of Regensburg St. Josef Medical Centre, Regensburg, Germany

    Maximilian Burger

Section Editor information

  1. Martini-Klinik am UKE GmbH, Hamburg, Germany

    Thomas Steuber

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Ceci, F., Fanti, S., Walz, J. (2018). Local and Systemic Staging by Modern Imaging Modalities in Prostate Cancer. In: Merseburger, A., Burger, M. (eds) Urologic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42603-7_69-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42603-7_69-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42603-7

  • Online ISBN: 978-3-319-42603-7

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation