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Complications of Prostate Cancer Treatment: Spectrum of Imaging Findings¹

¹ From the Departments of Radiology (C.M.Y., M.P.B., P.R.) and Surgery (Division of Urology) (M.P.B., E.S.R.), University of Pennsylvania Medical Center, One Silverstein, 3400 Spruce St, Philadelphia, PA 19104. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received January 30, 2004; revision requested March 3 and received April 28; accepted May 5. All authors have no financial relationships to disclose. Address correspondence to M.P.B. (e-mail: marc.banner@uphs.upenn.edu).

The imaging appearances of prostate cancer are well described in the radiology literature, but little has been written about the detection and appearance of the complications of therapy for this disease. The most frequently used treatments for prostate cancer are surgical therapy (eg, radical retropubic prostatectomy, radical perineal prostatectomy), radiation therapy (eg, brachytherapy, external-beam radiation therapy, three-dimensional conformal radiation therapy, intensity-modulated radiation therapy), and cryoablative therapy, each of which may lead to complications with characteristic imaging appearances. Possible complications include lymphocele formation; injuries to the ureter, rectum, and urethra; prostatic necrosis; vesicourethral anastomotic leak and stricture; urethral stricture, necrosis, and fistula; radiation proctitis; transient bladder outlet obstruction; radiation-induced urethritis; urinary incontinence; and erectile dysfunction. With improvements in surgical techniques and advances in technology, complications of therapy for prostate cancer are decreasing but still occur with sufficient frequency to warrant familiarity on the part of radiologists. Knowledge of the diverse spectrum of these complications and their characteristic radiologic features facilitates prompt diagnosis and treatment.

© RSNA, 2004

Index Terms: Prostate neoplasms, 844.32, 844.33 • Prostate neoplasms, MR, 844.1214 • Prostate neoplasms, surgery, 844.458 • Prostate neoplasms, therapeutic radiology, 844.1299 • Prostate neoplasms, therapy • Radiations, injurious effects, complications of therapeutic radiology, 844.47