Abstract

This review highlights both the consensus and variation in current imaging guidelines for the diagnosis, staging, and monitoring of prostate cancer, as well as the methods and expertise that these recommendations originate from.

Prostate cancer is the second most common malignancy among male individuals in the United States and requires careful imaging approaches because of its varied presentations. This review examines prostate cancer imaging guidelines from leading organizations, including the American College of Radiology, American Urological Association, European Association of Urology, American Society of Clinical Oncology, and National Comprehensive Cancer Network, and serves as a reference highlighting commonalities and divergences in current imaging recommendations across prostate cancer states. We outline these organizations and their methods, focusing on their approaches to panel expertise, guideline development, evidence grading, and revision schedules. We then compare and contrast the role of various imaging modalities across states of prostate cancer management in the following categories: clinically suspected prostate cancer, clinically established prostate cancer: active surveillance or staging, monitoring metastatic disease, and posttreatment follow-up: recurrent or residual disease. Overall, there is consensus on the importance of multiparametric MRI in diagnosis and staging prior to active surveillance and the emerging role of prostate-specific membrane antigen (PSMA) PET/CT in metastatic and recurrent disease. However, there is disparity in imaging recommendations for detecting metastases in unfavorable intermediate-risk prostate cancer and views on current applications of PSMA PET/CT. Ultimately, variations in radiologic expertise exist among guideline panels, and there continue to be inconsistencies in imaging recommendations in prostate cancer.