Table 2. Imaging modalities in high risk prostate cancer.

Modality	Detection of ECE∼	Detection of SVI∼	Detection of positive LN∼	Advantages and limitations
CT	Sensitivity = 0.75 Specificity = 0.6 40	Sensitivity = 0.33 Specificity = 0.6 40	Sensitivity = 0.42 (0.26-0.56) Specificity = 0.82 (0.8-0.83)41	Not useful for determining the local extent of disease and for local staging40 Performs poorly in the detection of lymph node metastases41
MRI (overall)#	Sensitivity = 0.57 (0.49–0.65) Specificity = 0.91 (0.88–0.93)32	Sensitivity = 0.58 (0.47–0.68) Specificity = 0.97 (0.95–0.98)32	Sensitivity = 0.39 (0.22-0.56) Specificity = 0.82 (0.79-0.83)41	Overall, MRI has high specificity but poor and heterogeneous sensitivity for local PCa staging32 mpMRI can accurately detect small-volume significant tumors, localize and stage PCa31 May be used for fusion biopsies with TRUS and post treatment local surveillance31 May be used to predict PCa aggressiveness33-35 Performs poorly in the detection of lymph node metastases41
mpMRI	1.5T with coil: Sensitivity = 0.84 Specificity = 0.89 3T without coil: Sensitivity = 0.71 Specificity = 0.91 31	Sensitivity = 0.61-0.78 Specificity = 0.96-0.9831
PET choline&	Sensitivity = 0.27 PPV = 0.5743	Sensitivity = 0.66 PPV = 0.6643	Sensitivity = 0.49 (0.4-0.58) Specificity = 0.95 (0.92-0.97)42	May improve detection and localization of cancerous foci especially when combined with mpMRI37 PSMA-PET-MRI can be used to perform targeted biopsies, increasing the diagnostic performance of the biopsies37 May improve detection of metastatic spread37 May be used to identify recurrent prostate cancer, including at serum PSA values < 0.5 ng/ml37 Not all prostate cancers have substantial PSMA overexpression37 PSMA is not globally available due to regulatory restrictions and not reimbursed by health care providers37
PET PSMA%	Sensitivity = 0.5 Accuracy = 0.7138	Sensitivity = 0.73 Specificity = 138	Sensitivity = 0.66 (0.49-0.8) Specificity = 0.99 (0.94-1)39

ECE = extra-capsular extension; SVI = seminal vesicle invasion; LN = lymph node; CT = computed tomography; MRI = magnetic resonance imaging; mpMRI = multi-parametric magnetic resonance imaging; PCa = prostate cancer; TRUS = trans-rectal ultrasound; PET = positron emission tomography; PPV = positive predictive value; PSMA = prostate-specific membrane antigen; PSA = prostate specific antigen

^∼Values represent percent and 95% confidence intervals.

^#Endorectal coil slightly improves sensitivity for identifying SVI; sensitivity may be improved with higher field strength and the use of functional imaging techniques.

^&Values for detecting ECE and SVI were obtained when using a ¹¹C-choline PET combined with computed tomography.

^%Values for detecting ECE and SVI were obtained when using PET-PSMA combined with computed tomography.