Imaging Frequency for Localized High-Risk Prostatic Acinar Adenocarcinoma

Initial Staging Recommendations

The American Urological Association recommends that clinicians should obtain a bone scan AND either pelvic multi-parametric MRI (mpMRI) or CT scan for all patients with high-risk prostate cancer at diagnosis (Strong Recommendation; Evidence Level: Grade B) 1, 2, 3
mpMRI is preferred for local tumor staging as it provides better assessment of local extent of disease 2, 4
CT scan of abdomen and pelvis should be performed to evaluate for nodal metastases 5

In patients with high-risk disease who have negative conventional imaging, molecular imaging (next-generation imaging) may be obtained to evaluate for occult metastases (Expert Opinion) 3, 4
FDA-approved options include Gallium 68 PSMA-11 PET scan and piflufolastat F-18 PSMA PET scan, which have 27% greater accuracy than conventional imaging 4
Molecular imaging should be considered when treatment decisions would be altered by the detection of metastatic disease 4, 6

The European Association of Urology recommends CT scans every 6 months (59% of expert panel consensus) 7, 8
Bone scans should be performed every 6 months (59% of expert panel consensus) 7, 8
More frequent imaging (every 2-4 months) may be considered in patients with concerning features or borderline findings on initial imaging 7

Imaging frequency may be adjusted based on PSA doubling time, changes in symptoms or performance status, and initial disease burden 6, 7
The National Comprehensive Cancer Network recommends that PSA should be measured every 3-4 weeks (44%) or every 2-4 months (34%) 8
Rising PSA alone should not trigger treatment changes without corresponding imaging confirmation 7, 8

Baseline imaging within 3-6 months after completion of therapy is recommended by the American Society of Clinical Oncology 5
Then follow the standard 6-month imaging protocol 7, 8
More frequent imaging may be warranted with PSA rise or clinical changes 6