Preoperative Imaging Studies

More accurate pre-treatment staging of prostate cancer allows an appropriate selection of therapy and increases the likelihood of favourable treatment outcome. Indeed, tables and nomograms do not incorporate imaging staging although these explorations could be useful. Traditional transrectal ultrasonography does not offer additional information compared to DRE and CTscan is not useful in local staging. MRI eventually completed by metabolic informations could help but only for patients with high risk features in whom microscopic local extension has not been detected. Routine studies (CTscan and MRI) are disappointing for lymph node assessment. Performed in high risk patients they can detect nodal metastasis, but their normality does not allow the practitioner to avoid pelvic lymphadenectomy. Ultra small paramagnetic oxide (USPIO) is very promising but still experimental. In high risk patients, radionuclide bone scan has to be performed. In case of abnormalities, confirmatory studies (X-rays, CTscan or MRI) are requested.