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What imaging workup should be completed in patients with a detectable PSA following prostatectomy?
Should the workup change with the PSA level (for example, >2 vs <2 ng/ml post-op PSA)? Is there a PSA level for which salvage radiotherapy should be withheld, even though metastatic workup is negative?
Answer from: Radiation Oncologist at Academic Institution
The imaging work-up of recurrent prostate cancer is a topic of considerable interest. Our approach at UCLA has been to recommend, at the very least, a multiparametric MRI to evaluate for locoregional recurrence, and we regularly recommend a technetium bone scan as well. That being stated, we have be...
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Answer from: Radiation Oncologist at Community Practice
Although it is important to rule out distant disease in the setting of a rising PSA, the diagnostic yield of imaging tends to be low unless the absolute PSA is high or the PSA velocity is high or the doubling time is very low.For bone scans, in a study of over a 120 patients, the yield of positive s...