Purpose of review: To review contemporary imaging of pelvic lymph nodes in patients with prostate cancer as well as to analyze its significance and usefulness in clinical practice.
Recent findings: Because of poor sensitivity and specificity of computed tomography (CT) and MRI, new imaging modalities of lymph nodes in prostate cancer patients would be desirable. Three-dimensional reconstruction by fusion imaging between single-photon emission computed tomography after injection of Tc-99m colloid particles into the prostate and CT or MRI, has permitted a precise mapping of the primary lymphatic landing sites, or sentinel lymph nodes of the prostate. Intraoperative search for sentinel lymph nodes by γ-probe in open and laparoscopic surgery is possible. Routine use of choline PET/CT for initial staging of prostate cancer is not yet recommended. MRI combined with ultrasmall particles of iron oxide (USPIO) permits differentiation with a very high sensitivity between benign and malignant lymph nodes, independently of their size. Diffusion-weighted MRI combined with USPIO is a promising method for detecting lymph nodes metastases even in normal sized nodes. Both improved MRI methods are not yet introduced in routine clinical practice.
Summary: USPIO-MRI or/with diffusion-weighted MRI seems to be a promising noninvasive imaging modality for accurate imaging of lymph nodes in patients with prostate cancer.