ABSTRACT

Prostate cancer is the most commonly diagnosed malignancy and third cause of cancer death. A substantial proportion of patients who have undergone a radical prostatectomy for localized prostate cancer will have either persistently elevated prostatespecific antigen (PSA) or delayed rise in PSA. The critical diagnostic dilemma in rising PSA after radical prostatectomy is the differentiation of patients with local recurrence only from patients with metastatic disease. The ideal treatment for these patients is not known. Current imaging techniques are limited by poor sensitivity, especially in low PSA (<5 ng/ml.). We review various current and investigational imaging modalities, including ultrasound, elastography, magnetic resonance imaging, bone scan, computed tomography, positron emission tomography and ProstaScint in the situation of rising PSA after radical prostatectomy and their limitations.