No imaging studies are indicated at this time. The United States Preventive Services Task Force has concluded that the harms of screening for prostate cancer outweigh the benefits in men of any age regardless of risk factors. In contrast, the American Cancer Society and American Urological Association recommend offering both serum prostate-specific antigen (PSA) measurement and digital rectal examination to men annually beginning at the age of 50 years. The American College of Physicians and American Academy of Family Physicians both recommend that clinicians have individualized discussions with their patients regarding obtaining PSA measurements and support measuring PSA levels after such discussions in patients 50 years and older who have life expectancies of at least 10 years. This patient has low-risk prostate cancer based on the presence of a TNM stage T1c tumor (identified after an elevated screening serum PSA level is found in the absence of symptoms), a serum PSA level less than 10 ng/mL (10 µg/L), and a Gleason score less than 8. Imaging studies are currently not recommended for men with low-risk disease, as there is no evidence that such studies reliably alter management decisions.

Prostate cancer is among the most commonly diagnosed cancers in men in the United States. Most men are diagnosed with clinically occult cancer, which is identified on the basis of an abnormal serum PSA value. Most often, there are no symptoms or indicative physical findings as in the patient described here. Once the diagnosis of prostate cancer is made, the focus moves to assessment and treatment decision making. The role of imaging studies in men diagnosed with prostate cancer is to assess disease status, particularly the presence of metastatic disease. Imaging studies are indicated to evaluate symptoms suggestive of metastatic disease and also to evaluate patients at high risk for occult metastatic disease. Currently accepted parameters for imaging studies include a serum PSA level of 20 ng/mL (20 µg/L) or higher, a PSA level of 10 ng/mL (10 µg/L) or higher associated with a T2 tumor, a Gleason score of 8 or higher, or a T3 or T4 tumor.