The role of computerized tomography, magnetic resonance imaging, bone scan, and monoclonal antibody nuclear scan for prognosis prediction in prostate cancer.

The single most important issue in determination of treatment options for prostate cancer is accurate assessment of disease extent. Some prediction of probability is afforded by algorithms of patient and tumor characteristics, but definitive detection of disease extension before this decision often remains difficult. This is the critical issue in the healthy 58-year-old man depicted with relatively high-grade, high-volume prostate cancer and a moderately low serum PSA relative to these characteristics. Any combination of choices for evaluation and treatment of this patient is likely to generate some controversy. This article discusses both the changing trends in treatment patterns, which place more emphasis on noninvasive staging and the limited value of conventional radiographic evaluation to detect small volume or microscopic disease. Recent advances in imaging techniques with magnetic resonance and radiolabeled monoclonal antibodies may provide more precise localization of prostate cancer in these clinical circumstances. The relative merits and limitations of the current and selected emerging imaging technology for prostate cancer detection are provided in this article.