Cat scanning in staging of prostatic cancer

doi:10.1016/0090-4295(81)90374-5

Urology

Volume 18, Issue 3, September 1981, Pages 305-308

https://doi.org/10.1016/0090-4295(81)90374-5 Get rights and content

Abstract

Forty-six patients with histologically proved adenocarcinoma of the prostate underwent pelvic lymphadenectomy after CAT scanning. The accuracy, specificity, and sensitivity of the CAT scan in detecting nodal metastasis were 70, 93 and 30 per cent, respectively; this compares favorably with pedal lymphangiography. Seventeen of the patients had radical prostatectomy. The accuracy, specificity, and sensitivity of the CAT scan in depicting local extent of the tumor were 47, 100, and 18 per cent, respectively; although low, no other clinical or biochemical method provides a better result.

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Cited by (68)

Salvage therapy of small volume prostate cancer nodal failures: A review of the literature
2014, Critical Reviews in Oncology/Hematology
Citation Excerpt :
Furthermore, it is well known that also benign conditions could be responsible of enlarged LNs. Tables 1 and 2 summarize the most relevant prospective trials exploring the efficacy of conventional CT scan [12–17] and MRI [12,17–25] to identify prostate cancer nodal metastases, using a reliable pelvic nodal dissection (PLND) or accurate biopsies as reference tests. The sensitivity values represent the great limit of both the techniques: with values ranging between 25% and 78% for the CT scan and between 0% and 86% for the standard MRI, respectively, with a large number of LNMs undetected.
New imaging modalities may be useful to identify prostate cancer patients with small volume, limited nodal relapse (“oligo-recurrent”) potentially amenable to local treatments (radiotherapy, surgery) with the aim of long-term control of the disease, even in a condition traditionally considered prognostically unfavorable. This report reviews the new diagnostic tools and the main published data about the role of surgery and radiation therapy in this particular subgroup of patients.
The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis
2008, Clinical Radiology
To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of lymph node metastases in prostate cancer.
After a comprehensive literature search, studies were included that allowed construction of contingency tables for detection of lymph node metastases using CT or MRI. In addition, a summary receiver-operating characteristic (ROC) analysis was performed.
A total of 24 studies were included. For CT, pooled sensitivity was 0.42 (0.26–0.56 95% CI) and pooled specificity was 0.82 (0.8–0.83 95% CI). For MRI, the pooled sensitivity was 0.39 (0.22–0.56 95% CI) and pooled specificity was 0.82 (0.79–0.83 95% CI). The differences in performance of CT and MRI were not statistically significant.
CT and MRI demonstrate an equally poor performance in the detection of lymph node metastases from prostate cancer. Reliance on either CT or MRI will misrepresent the patient's true status regarding nodal metastases, and thus misdirect the therapeutic strategies offered to the patient.
The Evolution of Imaging in Advanced Prostate Cancer
2006, Urologic Clinics of North America
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Conventional CT and MRI use size criteria to declare metastases in lymph nodes (threshold dimensions >10 mm in the short axis diameter of an elongated node or 8 mm in diameter if the lymph node is round), but use of size criteria has low sensitivity. Several studies cite that the sensitivity of CT for lymph node metastases ranges from 25% to 78%, and specificity ranges from 77% to 98% [25–28]. In one of the few studies that showed tissue confirmation of radiographic findings, CT had a sensitivity of 4% in a cohort of intermediate to high-risk patients [29].
Baseline staging of newly diagnosed prostate cancer: A summary of the literature
2004, Journal of Urology
Staging for prostate cancer often includes bone scanning and computerized tomography (CT). We systematically reviewed the published evidence for these tests.
We searched MEDLINE for articles on these investigations in newly diagnosed cases of prostate cancer. Data were pooled based on prostate specific antigen (PSA), grade and tumor stage.
Among 23 studies examining the role of bone scan metastases were detected in 2.3%, 5.3% and 16.2% of patients with PSA levels less than 10, 10.1 to 19.9 and 20 to 49.9 ng/ml, respectively. Scanning detected metastases in 6.4% of men with organ confined cancer and 49.5% with locally advanced disease. Detection rates were 5.6% and 29.9% for Gleason scores 7 or less and 8 or greater, respectively.
Among 25 studies CT documented lymphadenopathy in 0 and 1.1% of patients with PSA less than 20 and 20 ng/ml or greater, respectively. CT detection rate was 0.7% and 19.6% in patients with localized and locally advanced disease, respectively. Detection rates in patients with Gleason scores 7 or less and 8 or greater were 1.2% and 12.5%, respectively. These risks were typically much greater on pathological evaluation.
Patients with low risk prostate cancer are unlikely to have metastatic disease documented by bone scan or CT. Therefore, these investigations should not be standard practice. However, patients with PSA 20 ng/ml or greater, locally advanced disease, or Gleason score 8 or greater are at higher risk for bone metastases and should be considered for bone scan. CT may be useful in patients with locally advanced disease or Gleason score 8 or greater but appears not to be of benefit in patients with increased PSA alone.
The role of staging CT scans in the treatment of prostate cancer: A retrospective audit
2000, Clinical Oncology
A retrospective audit was performed to review the use of diagnostic and planning computed tomographic (CT) scans in the management of patients treated with radical radiotherapy for prostate cancer at Mount Vernon Hospital. All 97 patients had a planning CT scan. In addition, 85 also underwent a diagnostic scan for staging purposes. Fifty-one (60%) had both pelvic and abdominal imaging.
Twenty abnormalities were detected in 19 patients. Although 13 of these were ‘malignant’ abnormalities considered to represent metastatic disease, only four altered the treatment intent. Overall, only 4% of patients were denied radical treatment on the basis of CT findings. Malignant intra-abdominal disease was not identified in the absence of metastatic disease in the pelvis.
This study confirms that abdominal CT scans contribute very little useful prognostic information in men with prostate cancer, and are not necessary for routine staging prior to radiotherapy. We propose that a single CT scan of the pelvis in patients who are suitable for radical radiotherapy can provide adequate information for both staging and planning purposes, resulting in significant reductions in cost, radiation exposure and scanner time.
The prostate: Diagnostic evaluation of metastatic disease
2000, Radiologic Clinics of North America
Citation Excerpt :
False-negative diagnoses result when metastases occur in normal-sized nodes, and false-positive diagnoses result when lymph node enlargement is due to benign hyperplastic changes. The sensitivity of CT for detecting lymph node metastases ranges from 25% to 78%, with specificity of 77% to 98% and accuracy of 70% to 94%.14,37,44,54 Lowering the size threshold decreases the false-negative rate but increases the false-positive rate for the diagnosis of lymph node metastases.
Among patients with prostate cancer, those who have metastatic disease have the worst prognosis.40, 43 Prout et al,⁴³ for example, reported that 46% of patients with metastatic disease died (on average) about 22 months after diagnosis, whereas disease progression occurred in only 10% of patients who did not have evidence of metastatic disease. Perez⁴⁰ reported that in patients with clinically localized disease treated by external-beam radiation therapy, no patient with lymph node metastases survived at 10-year follow-up. The identification and exclusion of metastatic disease, therefore, is very important to treatment decision making in patients with prostate cancer.

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UroradiologyCat scanning in staging of prostatic cancer

Abstract

Urology

J. Urol.

J. Urol.

Urol. Clin. North Am.

Uroradiology
Cat scanning in staging of prostatic cancer