title: ACR Appropriateness Criteria prostate cancer--pretreatment detection, staging, and surveillance.
abstract: Prostate cancer is the most common noncutaneous male malignancy in the United States. The use of serum prostate-specific antigen as a screening tool is complicated by a significant fraction of nonlethal cancers diagnosed by biopsy. Ultrasound is used predominately as a biopsy guidance tool. Combined rectal examination, prostate-specific antigen testing, and histology from ultrasound-guided biopsy provide risk stratification for locally advanced and metastatic disease. Imaging in low-risk patients is unlikely to guide management for patients electing up-front treatment. MRI, CT, and bone scans are appropriate in intermediate-risk to high-risk patients to better assess the extent of disease, guide therapy decisions, and predict outcomes. MRI (particularly with an endorectal coil and multiparametric functional imaging) provides the best imaging for cancer detection and staging. There may be a role for prostate MRI in the context of active surveillance for low-risk patients and in cancer detection for undiagnosed clinically suspected cancer after negative biopsy results. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors: University of New Mexico, Albuquerque, New Mexico, USA. seberhardt@salud.unm.edu
authors: Steven C
authors: SC
authors: Eberhardt
authors: Scott
authors: S
authors: Carter
authors: David D
authors: DD
authors: Casalino
authors: Gregory
authors: G
authors: Merrick
authors: Steven J
authors: SJ
authors: Frank
authors: Alexander R
authors: AR
authors: Gottschalk
authors: John R
authors: JR
authors: Leyendecker
authors: Paul L
authors: PL
authors: Nguyen
authors: Aytekin
authors: A
authors: Oto
authors: Christopher
authors: C
authors: Porter
authors: Erick M
authors: EM
authors: Remer
authors: Seth A
authors: SA
authors: Rosenthal
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008495:Medical Oncology / Q000592:standards*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011871:Radiology / Q000592:standards*; D014481:United States