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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
From:
AJR Am J Roentgenol. Author manuscript; available in PMC 2010 June 28.
Published in final edited form as:
AJR Am J Roentgenol. 2009 June; 192(6): 1455–1470.
doi: 10.2214/AJR.09.2579

TABLE 2

Prostate Cancer Risk Definitions, Incidence, Screening Parameters, Treatments, and Imaging Use
Risk CategoryaIncidenceDefinitionScreening ParametersDisease Management/TreatmentsTreatment TrendsaImaging Techniques Used to Monitor and Stageb

NormalNAAge≥55y, normal PSA and DRERegular PSA and/or DRE screeningNoneNoneNone
ElevatedNAPSA>4 ng/mL, negative biopsy or HGPINActive surveillance to differentiate BPHPeriodic repeat biopsy, dietary and lifestyle modificationNATRUS, MRI
Low34PSA ≤ 10 ng/mL, Gleason score < 6, and stage T1–T2aConfirmed cancer, tumor confined to prostate, no extracapsular penetrationPossibly neoadjuvant hormonal therapy or focal treatmentWatchful waiting (8.9), brachytherapy (18.4) external-beam RT (6.8), prostatectomy (52), ADT (14.2)CT (10.4), MRI (0.9), bone scanning (18.6)
Intermediate36PSA 10.1–20 ng/mL, Gleason score 7, and stage T2bConfirmed cancer, tumor confined to prostate, no extracapsular penetrationRadiation therapy (brachytherapy, external-beam irradiation), RPWatchful waiting (4.5), brachytherapy (11.8), external-beam RT (19.1), prostatectomy (45), ADT (19.7)CT (15.3), MRI (1.4), bone scanning (50.9)
High30PSA > 20 ng/mL, Gleason score 8–10, and stage T3–T4TMN, extracapsular extension, local lymph nodes, seminal vesicles, pelvic structuresSame as for intermediate risk plus pelvic dissection, increased radiation field, ADTWatchful waiting (4.8), brachytherapy (2.4), external-beam RT (23), prostatectomy (22.7), ADT (48.2)CT (25), MRI (2.5), bone scanning (69)
Relapse or recurrence after definitive therapy30–50% of previously treated patientsAny PSA after nadir (RP vs RT definitions distinct)PSA doubling timeADT, salvage RT, RP; if moving toward advanced disease, treatment and techniques are indicated belowNo definitive data of overall trends for ADT; possibly adjuvant, cytotoxics, etc.Multiple techniques used: TRUS, CT, MRI, MRS, DWI, DCE-MRI, bone scanning, ProstaScintd, FDG PET; 18F-NaF, FLT, FDHT, etc.; no definitive data on trends for extent of use; radiolabeled choline, acetate
Advanced disease, bone metastasescNAVisceral, axial, or appendicular skeletal lesionsPain, markedly elevated PSA, bone scanning-detected lesionsADT, bisphosphonates, chemotherapy, RT, bone-targeted radioisotopesFDA-approved therapies (e.g., docetaxel) vs investigational drugsMultiple techniques used: TRUS, CT, MRI, MRS, DWI, DCE-MRI, bone scanning, ProstaScintd, FDG PET; 18F-NaF, FLT, FDHT, etc.; no definitive data on trends for extent of use; radiolabeled choline, acetate

Note—Numbers in parentheses are percentages. PSA = prostate-specific antigen, DRE = digital rectal examination, HGPIN = high-grade prostatic intraepithelial neoplasia, BPH = benign prostatic hyperplasia, TRUS = transrectal ultrasound, RP = radical prostatectomy, RT = radiation therapy, ADT = androgen deprivation therapy, MRS = MR spectroscopy, DWI = diffusion-weighted MRI, DCE-MRI = dynamic contrast-enhanced MRI, FDG PET = 18fluoro-2-deoxyglucose PET, 18F-NaF = 18F sodium fluoride, FLT = 18F-3′-fluoro-3′-deoxy-L-thymidine, FDHT = 18F-fluorodihydrotestosterone, N A = not available.

aBased on 1999–2001 data; adapted from [101].
bData are based on information available through 1997. Since that time, there has been increased use of MRI. Adapted from [102].
cMedian actuarial time to metastases = 8 years from biochemical recurrence and median time to death after metastases detected = 5 years [66].
dProstaScint: 111In-capromab pendetide manufactured by Cytogen.