The prostate: Diagnostic evaluation of metastatic disease

One of the single most important considerations in clinical management of t he patient with prostate cancer is whether or not metastatic disease is pre sent. The identification of metastatic disease in a patient with newly diag nosed prostate cancer represents an absolute contraindication to definitive local therapies such as radial prostatectomy or radiation therapy. Similar ly, the identification of metastatic disease in a patient with disease recu rrence after definitive local therapy represents an absolute contraindicati on to salvage radiotherapy or cryosurgery. Patients with metastatic disease do not benefit from definitive therapy, and the cost and morbidity associa ted with such treatment should therefore be avoided in these patients. Beca use of the significance of metastatic disease to clinical management, it is important for the diagnostic radiologist to be aware of important consider ations in the metastatic work-up of patients with newly diagnosed prostate cancer and patients with suspected cancer recurrence after definitive local therapy.