Prostate Cancer on CT

Prostate cancer is one of he more common cancers found in men as they get older.  Unfortunately, most prostate cancers can not be seen on CT.    CT does show us the prostate gland, but CT rarely shows more then that.  In other words, prostate abnormalities like cancer, may be present but we can’t see it on CT.

What tests show us prostate abnormalities?

There are blood tests like PSA which can be elevated in prostate cancer and other conditions of the prostate such as enlargement or inflammation.  Prostate MRI is one of the better imaging tests for identifying cancer of the prostate.  Nevertheless, we can sometimes see cancer on CT.

Prostate cancer on CT

Cancer of the prostate will be seen as a mass or abnormal area in the gland.  Unfortunately, even when we do see mass or abnormal area, it may be related to age related enlargement or hyperplasia.   Therefore, CT will rarely identify a primary cancer without spread to other parts of the body.

Most of the time prostate cancer will be seen along the peripheral zone, or the periphery of the gland.  Rarely, we can see a mass,  bulge or asymmetry along the back peripheral part of the gland.  We can sometimes see a mass invading other adjacent organs like the bladder or seminal vesicles which lie on top of the prostate.

CT is best for prostate cancer which has spread

More commonly, we see prostate cancer which has already spread on CT.  This is common to the bones where we see sclerotic or whiter then bone lesions.  Prostate cancer can also spread to other organs like the liver and lymph nodes.  Prostate cancer can spread to the lungs and cause spots or nodules to form.  We can see these findings well on CT.

We also use CT to monitor response to treatment and for recurrence in patients whose cancer has spread.  This will often show as spread to lymph nodes, bones, organs or lungs.  We compare to prior scans for changes.  Sometimes additional imaging will be needed like a PET scan for prostate cancer to further evaluate.

What is done for a suspicious finding on CT in the prostate

Suspicious findings on CT in the prostate gland are often further imaged with prostate MRI.  MRI of the prostate allows a detailed look at the prostate.  We can see cancer in many cases.  We can also see inflammation, abscesses, benign nodules and enlargement.  Some abnormalities on MRI which are concerning for cancer will be biopsied by a urologist.

CT is commonly done and we see the prostate gland on all these studies in men.  We sometimes see findings of the prostate, but further imaging with MRI or biopsy is needed to provide a diagnosis.   CT is best for identifying spread of cancer to other parts of the body.  It can also identify enlargement and abscesses or pockets of pus.

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