In biochemical recurrence after curative treatment of prostate cancer, Choline PET/CT1- has a detection rate of 10-20% when PSA: 1-2 ng/ml2- has a detection rate of 81% when PSA dt is less than 3 months3- it best identifies patients with bone metastases4- PET/CT is indicated for pre-op staging in case of suspicious MRI

• 2-A negative Choline PET/CT • is not sufficient to rule out the indication

for lymph-adenectomy• a-true• b-false

• A 67 year old man has a T2b prostate cancer Gleason score 8, PSA: 8.7ng/ml. mpMRI shows extracapsular extension on the right , no enlarged lymph nodes

1- a bone scan is necessary 2- bone scan is more accurate for osteoclastic lesions 3- mp MRI of the prostate can detect all bone metastases 4- DW total body MRI is more sensitive than bone scan to R/O bone metastases

• The use of choline PET/CT for preoperative LN staging:

1- is indicated 2- high sensitivity but poor specificity 3- should be limited to patients with very high risk for LN positive status according to nomograms4- has a low positive predicted value

PET choline for detection of LN and distant recurrence in PC patients with biochemical recurrence

1- Significantly high detection rate with PSA <1 ng/ml

2- The Trigger PSA value is = or > 5g/ml

3- No relationship between detection rate and PSA kinetics 4- A crucial role as first diagnostic procedure in patients who demonstrate a fast growing PSA kinetics and low Trigger PSA

choline PET/CT

1- could play a crucial role as first diagnostic procedure in PC patients 2- It is not recommended for initial diagnosis and staging as a first-line method3- PSA dt could not be considered as an independent predictor of positive choline PET/CT4- 18f choline PET/CT is not accurate to detect distant recurrence

Dynamic Contrast Study

1. Based on density of tumor cells 2. Early enhancement of tumoral tissue in T2-

weighted MRI 3. Delayed wash out of contrast agent are seen

in prostate cancer4. Early enhancement of tumoral tissue in T1 -

weighted MRI

Diffusion Weighted Imaging

1. Works based on angiogenesis2. Water molecules movement increases in a high

cellular environment3. Sensitivity and specificity of DWI when added

to T2-Weighted MRI for detecting prostate cancer is about 84% and 87% respectively

4. DW-MR imaging alone shows high sensitivity in cancer recurrence detection after radiotherapy

MR Spectroscopy

1. Combination of choline and fluorocholine is measured in MRS

2. Citrate accumulates in the T zone

3. Citrate is higher in malignant prostatic tissue

4. A higher ratio of Cho+Cr/Ci (more than 0.75 ) is in favor of high risk of malignancy

Regarding the use of Multiparametric MR imaging select the wrong answer

• Detection and local staging of prostate cancer • Follow-up of patients after radical

prostatectomy or radiation therapy • Detection of skeletal metastasis • Targeting biopsies in patients suspicious of

prostate cancer