American College of Radiology
ACR Appropriateness Criteria®

Post-treatment Follow-up of Prostate Cancer

Variant 1: Prostate cancer follow-up. Status post radical prostatectomy. Clinical concern for residual or recurrent disease.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 1 0 2 9 2
C-11 choline PET/CT skull base to mid-thigh Usually appropriate ☢☢☢ 1-10 mSv 8 8 0 0 0 0 0 2 4 8 1
F-18 fluciclovine PET/CT skull base to mid-thigh Usually appropriate ☢☢☢☢ 10-30 mSv 7 7 0 0 1 1 0 4 3 4 2
CT abdomen and pelvis with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 6 6 0 0 0 1 6 7 0 0 1
MRI-targeted biopsy prostate May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 1 3 9 2 0 0
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 3 0 1 7 0 5 0 2 0 0
Tc-99m bone scan whole body May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 1 0 1 9 0 0 3 1
TRUS guided biopsy prostate May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 0 0 6 3 1 3 0 1
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 2 7 2 3 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 2 5 2 3 1 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 5 5 4 0 0 0 0 0
MRI pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 2 5 4 2 1 0 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 0 4 4 2 2 1 0 1 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 4 4 3 1 1 1 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 2 2 2 10 1 1 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 2 2 4 6 3 1 0 0 0 0 0
Radiography skeletal survey Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 12 1 2 0 0 0 0 0 0
TRUS prostate Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 1 3 0 0 0 1 0 0
Variant 2: Prostate cancer follow-up. Clinical concern for residual or recurrent disease after nonsurgical local and pelvic treatments.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI pelvis without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 2 1 8 3
C-11 choline PET/CT skull base to mid-thigh Usually appropriate ☢☢☢ 1-10 mSv 8 8 0 0 0 0 0 2 3 9 1
TRUS guided biopsy prostate Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 2 1 3 7 1 0
F-18 fluciclovine PET/CT skull base to mid-thigh Usually appropriate ☢☢☢☢ 10-30 mSv 7 7 0 0 1 0 2 2 3 6 1
MRI-targeted biopsy prostate Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 4 1 7 2 0
CT abdomen and pelvis with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 1 6 6 1 0 0
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 4 0 0 4 4 5 0 2 0 0
Tc-99m bone scan whole body May be appropriate (Disagreement) ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 1 0 2 0 7 2 0 3 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 0 3 9 1 2 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 3 3 1 2 6 2 3 0 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 6 6 2 0 0 0 0 0
MRI pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 1 7 2 4 0 0 0 0
CT chest abdomen pelvis with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 1 3 4 2 2 1 0 1 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 5 3 3 2 0 1 1 0 0
TRUS prostate Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 3 2 1 1 0 1 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 2 2 3 9 1 1 0 0 0 0 0
CT chest abdomen pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 2 2 4 7 3 0 0 0 0 0 0
Radiography skeletal survey Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 2 0 0 0 0 0 0 0
Variant 3: Metastatic prostate cancer treated by systemic therapy (androgen deprivation therapy [ADT], chemotherapy, immunotherapy). Follow-up.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 0 1 5 5 3
Tc-99m bone scan whole body Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 0 0 1 3 7 4
C-11 choline PET/CT skull base to mid-thigh Usually appropriate ☢☢☢ 1-10 mSv 7 7 0 0 0 0 4 1 6 3 1
F-18 fluciclovine PET/CT skull base to mid-thigh Usually appropriate ☢☢☢☢ 10-30 mSv 7 7 1 0 0 0 1 5 3 4 1
MRI abdomen and pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 0 1 2 7 4 1 0
CT chest abdomen pelvis with IV contrast May be appropriate ☢☢☢☢ 10-30 mSv 6 6 0 0 1 1 3 3 1 4 1
MRI pelvis without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 1 3 3 6 2 0 0 0
MRI pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 1 2 2 6 2 1 1 0 0
FDG-PET/CT skull base to mid-thigh May be appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 4 4 0 0 1 7 2 4 1 0 0
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 5 5 2 2 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 0 2 7 3 2 1 0 0 0
CT chest abdomen pelvis without IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 3 3 1 6 4 1 1 1 0 0 0
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 2 6 5 0 1 0 0 0 1
CT chest abdomen pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv 2 2 3 5 3 1 0 1 1 0 0
TRUS prostate Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 12 2 1 0 0 0 0 0 0
Radiography skeletal survey Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 13 1 1 0 0 0 0 0 0
TRUS guided biopsy prostate Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 3 3 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.