The Current and Future Role of MRI and PSMA-PET/CT in Diagnosing Oligometastatic Prostate Cancer

Abstract

This review describes the role of different imaging techniques in the initial diagnosis and staging of prostate cancer (PCa), with a focus on oligometastatic disease. Men with an elevated prostate-specific antigen level and/or with an abnormal digital rectal exam are subject to a multiparametric MRI examination to identify a possible lesion in the prostate. In patients with high-risk or intermediate-risk disease with an unfavorable prognosis, additional imaging with prostate-specific membrane antigen (PSMA) PET/CT is offered to assess the presence of local nodal or extensive metastatic disease. Oligometastatic disease, which is PCa with a limited number of 1 to 5 metastatic deposits, possibly provides a time window to delay the course of the disease, or perhaps even still cure the patient. To detect these first metastases in small or normal-sized lymph nodes, the most sensitive, noninvasive imaging method should be selected. In this review, we summarize the current use of MRI and PSMA-PET/CT and discuss the latest developments in these techniques that could further improve initial diagnosis and staging of oligometastatic PCa.

Keywords: PSMA; USPIO; lymph nodes; metastases; prostate cancer; prostate-specific membrane antigenultrasmall superparamagnetic iron oxide; whole-body MRI.