Skip to main content Accessibility help
  • Print publication year: 2008
  • Online publication date: December 2009

8 - Computed tomography imaging in patients with prostate cancer



Prostate cancer has attracted a great deal of resources and effort in the scientific community not only because it is the most common malignancy and the third leading cause of cancer-related mortality in American men [1], but also because of its complex, often baffling nature. It demonstrates a wide clinical spectrum, from indolent disease that the patient will die with, rather than from, to highly aggressive disease that threatens the patient's life. One of the most important questions in managing prostate cancer, therefore, is how to stratify patients by their disease characteristics in order to design appropriate, individualized treatment plans. The use of imaging, which is an integral part of prostate cancer management, should also be guided by the patient's risk category, as determined by the patient's age, prostate-specific antigen (PSA) level, Gleason score, and number of positive biopsy cores [1].

In recent years computed tomography (CT) has undergone substantial technical improvements. With the introduction of high-speed multidetector helical scanners, it is now possible to acquire a CT study with high spatial resolution in a very short time. However, compared to magnetic resonance imaging (MRI), CT has poor soft-tissue resolution in the pelvis and therefore is not the modality of choice for evaluating primary prostate cancer.

It has been shown that in patients with low-risk prostate cancer the likelihood of positive findings on abdominal/pelvic CT is extremely low [2, 3]. Therefore, it has been recommended that CT be reserved for the staging of prostate cancer in high-risk patients.

Hricak, H., Choyke, P. L., Eberhardt, S. C., et al., Imaging prostate cancer: a multidisciplinary perspective. Radiology, 243 (2007), 28–53.
Huncharek, M., Muscat, J., Serum prostate-specific antigen as a predictor of radiographic staging studies in newly diagnosed prostate cancer. Cancer Invest, 13 (1995), 31–5.
Abuzallouf, S., Dayes, I., Lukka, H., Baseline staging of newly diagnosed prostate cancer: a summary of the literature. J Urol, 171 (2004), 2122–7.
Amis, Jr E. S.., Bigongiari, L. R., Bluth, E. I., et al., Pretreatment staging of clinically localized prostate cancer. American College of Radiology. ACR Appropriateness Criteria. Radiology 215:Suppl (2000), 703–8.
Carroll, P., Coley, C., McLeod, D., et al., Prostate-specific antigen best practice policy – part II: prostate cancer staging and post-treatment follow-up. Urology, 57 (2001), 225–9.
Saigal, C. S., Pashos, C. L., Henning, J. M., et al., Variations in use of imaging in a national sample of men with early-stage prostate cancer. Urology, 59 (2002), 400–4.
Kindrick, A. V., Grossfeld, G. D., Stier, D. M., et al., Use of imaging tests for staging newly diagnosed prostate cancer: trends from the CaPSURE database. J Urol, 160 (1998), 2102–6.
Yu, K. K., Hricak, H., Imaging prostate cancer. Radiol Clin North Am, 38 (2000), 59–85, viii.
Akin, O., Hricak, H., Imaging of prostate cancer. Radiol Clin North Am, 45 (2007), 207–22.
Engeler, C. E., Wasserman, N. F., Zhang, G., Preoperative assessment of prostatic carcinoma by computerized tomography. Weaknesses and new perspectives. Urology, 40 (1992), 346–50.
Platt, J. F., Bree, R. L., Schwab, R. E., The accuracy of CT in the staging of carcinoma of the prostate. AJR Am J Roentgenol, 149 (1987), 315–18.
Hricak, H., Dooms, G. C., Jeffrey, R. B., et al., Prostatic carcinoma: staging by clinical assessment, CT, and MR imaging. Radiology, 162 (1987), 331–6.
Henderson, E., Milosevic, M. F., Haider, M. A., et al., Functional CT imaging of prostate cancer. Phys Med Biol, 48 (2003), 3085–100.
Ives, E. P., Burke, M. A., Edmonds, P. R., et al., Quantitative computed tomography perfusion of prostate cancer: correlation with whole-mount pathology. Clin Prostate Cancer, 4 (2005), 109–12.
Padhani, A. R., Harvey, C. J., Cosgrove, D. O., Angiogenesis imaging in the management of prostate cancer. Nat Clin Pract Urol, 2 (2005), 596–607.
Prando, A., Wallace, S., Helical CT of prostate cancer: early clinical experience. AJR Am J Roentgenol, 175 (2000), 343–6.
Jeukens, C. R., Berg, C. A., Donker, R., et al., Feasibility and measurement precision of 3D quantitative blood flow mapping of the prostate using dynamic contrast-enhanced multi-slice CT. Phys Med Biol, 51 (2006), 4329–43.
Rietbergen, J. B., Hoedemaeker, R. F., Kruger, A. E., et al., The changing pattern of prostate cancer at the time of diagnosis: characteristics of screen detected prostate cancer in a population based screening study. J Urol, 161 (1999), 1192–8.
Lee, N., Newhouse, J. H., Olsson, C. A., et al., Which patients with newly diagnosed prostate cancer need a computed tomography scan of the abdomen and pelvis? An analysis based on 588 patients. Urology, 54 (1999), 490–4.
Huncharek, M., Muscat, J., Serum prostate-specific antigen as a predictor of staging abdominal/pelvic computed tomography in newly diagnosed prostate cancer. Abdom Imaging, 21 (1996), 364–7.
Spencer, J. A., Chng, W. J., Hudson, E., et al., Prostate specific antigen level and Gleason score in predicting the stage of newly diagnosed prostate cancer. Br J Radiol, 71 (1998), 1130–5.
O'Dowd, G. J., Veltri, R. W., Orozco, R., et al., Update on the appropriate staging evaluation for newly diagnosed prostate cancer. J Urol, 158 (1997), 687–98.
Levran, Z., Gonzalez, J. A., Diokno, A. C., et al., Are pelvic computed tomography, bone scan and pelvic lymphadenectomy necessary in the staging of prostatic cancer?Br J Urol, 75 (1995), 778–81.
Flanigan, R. C., McKay, T. C., Olson, M., et al., Limited efficacy of preoperative computed tomographic scanning for the evaluation of lymph node metastasis in patients before radical prostatectomy. Urology, 48 (1996), 428–32.
Schwartz, L. H., LaTrenta, L. R., Bonaccio, E., et al., Small cell and anaplastic prostate cancer: correlation between CT findings and prostate-specific antigen level. Radiology, 208 (1998), 735–8.
Moul, J. W., Kane, C. J., Malkowicz, S. B., The role of imaging studies and molecular markers for selecting candidates for radical prostatectomy. Urol Clin North Am, 28 (2001), 459–72.
Hricak, H., Schoder, H., Pucar, D., et al., Advances in imaging in the postoperative patient with a rising prostate-specific antigen level. Semin Oncol, 30 (2003), 616–34.
Tiguert, R., Gheiler, E. L., Tefilli, M. V., et al., Lymph node size does not correlate with the presence of prostate cancer metastasis. Urology, 53 (1999), 367–71.
Wolf, Jr J. S.., Cher, M., Dall'era, M., et al., The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol, 153 (1995), 993–9.
Oyen, R. H., Poppel, H. P., Ameye, F. E., et al., Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology, 190 (1994), 315–22.
Flocks, R. H., Culp, D., Porto, R., Lymphatic spread from prostatic cancer. J Urol, 81 (1959), 194–6.
Spencer, J., Golding, S., CT evaluation of lymph node status at presentation of prostatic carcinoma. Br J Radiol, 65 (1992), 199–201.
Fung, A. Y., Grimm, S. Y., Wong, J. R., et al., Computed tomography localization of radiation treatment delivery versus conventional localization with bony landmarks. J Appl Clin Med Phys, 4 (2003), 112–19.
Lee, D. J., Leibel, S., Shiels, R., et al., The value of ultrasonic imaging and CT scanning in planning the radiotherapy for prostatic carcinoma. Cancer, 45 (1980), 724–7.
Pilepich, M. V., Prasad, S. C., Perez, C. A., Computed tomography in definitive radiotherapy of prostatic carcinoma, part 2: definition of target volume. Int J Radiat Oncol Biol Phys, 8 (1982), 235–9.
Mens, J. W., Slotman, B. J., Meijer, O. W., et al., Effect of CT-based treatment planning on portal field size and outcome in radiation treatment of localized prostate cancer. Radiother Oncol, 55 (2000), 27–30.
Bellon, J., Wallner, K., Ellis, W., et al., Use of pelvic CT scanning to evaluate pubic arch interference of transperineal prostate brachytherapy. Int J Radiat Oncol Biol Phys, 43 (1999), 579–81.
Milosevic, M., Voruganti, S., Blend, R., et al., Magnetic resonance imaging (MRI) for localization of the prostatic apex: comparison to computed tomography (CT) and urethrography. Radiother Oncol, 47 (1998), 277–84.
Hocht, S., Wiegel, T., Bottke, D., et al., Computed tomogram prior to prostatectomy. Advantage in defining planning target volumes for postoperative adjuvant radiotherapy in patients with stage C prostate cancer?Strahlenther Onkol, 178 (2002), 134–8.
Roach, M., 3rd, Faillace-Akazawa, P., Malfatti, C., et al., Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys, 35 (1996), 1011–18.
Hoffelt, S. C., Marshall, L. M., Garzotto, M., et al., A comparison of CT scan to transrectal ultrasound-measured prostate volume in untreated prostate cancer. Int J Radiat Oncol Biol Phys, 57 (2003), 29–32.
Sannazzari, G. L., Ragona, R., Redda, M. G. Ruo, et al., CT-MRI image fusion for delineation of volumes in three-dimensional conformal radiation therapy in the treatment of localized prostate cancer. Br J Radiol, 75 (2002), 603–7.
Wachter, S., Wachter-Gerstner, N., Bock, T., et al., Interobserver comparison of CT and MRI-based prostate apex definition. Clinical relevance for conformal radiotherapy treatment planning. Strahlenther Onkol, 178 (2002), 263–8.
Berthelet, E., Liu, M. C., Agranovich, A., et al., Computed tomography determination of prostate volume and maximum dimensions: a study of interobserver variability. Radiother Oncol, 63 (2002), 37–40.
Zhou, S. M., Bentel, G. C., Lee, C. G., et al., Differences in gross target volumes on contrast vs. noncontrast CT scans utilized for conformal radiation therapy treatment planning for prostate carcinoma. Int J Radiat Oncol Biol Phys, 42 (1998), 73–8.
Kalkner, K. M., Kubicek, G., Nilsson, J., et al., Prostate volume determination: differential volume measurements comparing CT and TRUS. Radiother Oncol, 81 (2006), 179–83.
Porter, A. T., Blasko, J. C., Grimm, P. D., et al., Brachytherapy for prostate cancer. CA Cancer J Clin, 45 (1995), 165–78.
Gore, R. M., Moss, A. A., Value of computed tomography in interstitial 125I brachytherapy of prostatic carcinoma. Radiology, 146 (1983), 453–8.
Mizowaki, T., Cohen, G. N., Fung, A. Y., et al., Towards integrating functional imaging in the treatment of prostate cancer with radiation: the registration of the MR spectroscopy imaging to ultrasound/CT images and its implementation in treatment planning. Int J Radiat Oncol Biol Phys, 54 (2002), 1558–64.
Neill, M. G., Lockwood, G. A., McCluskey, S. A., et al., Preoperative evaluation of the “hostile pelvis” in radical prostatectomy with computed tomographic pelvimetry. BJU Int, 99 (2007), 534–8.
Kramer, S., Gorich, J., Gottfried, H. W., et al., Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy. Br J Radiol, 70 (1997), 995–9.
Strohmaier, W. L., Keller, T., Bichler, K. H., Follow-up in prostate cancer patients: which parameters are necessary?Eur Urol, 35 (1999), 21–5.
Yu, K. K., Hawkins, R. A., The prostate: diagnostic evaluation of metastatic disease. Radiol Clin North Am, 38 (2000), 139–57, ix.
Spencer, J. A., Golding, S. J., Patterns of lymphatic metastases at recurrence of prostate cancer: CT findings. Clin Radiol, 49 (1994), 404–7.
Glajchen, N., Shapiro, R. D., Stock, R. G., et al., CT findings after laparoscopic pelvic lymph node dissection and transperineal radioactive seed implantation for prostatic carcinoma. AJR Am J Roentgenol, 166 (1996), 1165–8.
Amdur, R. J., Gladstone, D., Leopold, K. A., et al., Prostate seed implant quality assessment using MR and CT image fusion. Int J Radiat Oncol Biol Phys, 43 (1999), 67–72.
Harvey, C. J., Blomley, M. J., Dawson, P., et al., Functional CT imaging of the acute hyperemic response to radiation therapy of the prostate gland: early experience. J Comput Assist Tomogr, 25 (2001), 43–9.
Harvey, C., Morgan, J., Blomley, M., et al., Tumor responses to radiation therapy: use of dynamic contrast material-enhanced CT to monitor functional and anatomical indices. Acad Radiol, 9:Suppl 1 (2002), S215–219.
Harvey, C., Dooher, A., Morgan, J., et al., Imaging of tumour therapy responses by dynamic CT. Eur J Radiol, 30 (1999), 221–6.