What prostate imaging?

[medicineradman]

Hi radiologists, I am a radiation oncologist. I have a patient that had robotic prostatectomy for intermediate risk PCa but had a post op PSA of 1.0 ng/ml. Im concerned the surgeon just missed some of the tumor, but they call his margins negative but + ECE. I want to visualize the prostate bed but also see if he has an enlarged nodes so I thought I would just get a pelvic MRI. I wanted to ask your help if you would get a endorectal MRI instead in this situation.

Knowing if he has tissue present in the bed would make me proceed with RT but also defer giving him hormones. If he does not have tissue present (and nodes are not concerning) then I would proceed with RT with hormones. So bottom line, if pelvic MRI would be sufficient for me to see gross disease in the bed then I would get that bc I can see nodes too, otherwise I would get endorectal MRI.

Appreciate you help on this one. Thank you

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[DrBowtie]

Hi radiologists, I am a radiation oncologist. I have a patient that had robotic prostatectomy for intermediate risk PCa but had a post op PSA of 1.0 ng/ml. Im concerned the surgeon just missed some of the tumor, but they call his margins negative but + ECE. I want to visualize the prostate bed but also see if he has an enlarged nodes so I thought I would just get a pelvic MRI. I wanted to ask your help if you would get a endorectal MRI instead in this situation.

Knowing if he has tissue present in the bed would make me proceed with RT but also defer giving him hormones. If he does not have tissue present (and nodes are not concerning) then I would proceed with RT with hormones. So bottom line, if pelvic MRI would be sufficient for me to see gross disease in the bed then I would get that bc I can see nodes too, otherwise I would get endorectal MRI.

Appreciate you help on this one. Thank you

If they have a 3T magnet, they can do imaging both of nodes and smaller FOV prostate bed sequences without an endorectal coil. You'd just have to discuss with them to see what their protocols involve.

Alternatively, are you near an academic center doing radio labeled choline or acetate PET/CT imaging? Seems promising in prostate cases just as you describe.