Distant Metastases

At presentation, distant metastases are present in only 3% of patients and are associated with a very poor prognosis, with the commonest sites lung, liver, and retroperitoneum, as well as bone.106 In likely node-positive cases an abdominal CT will image para-aortic nodes or liver, although MR is a sensitive method for the detection of abdominal nodes,107 retroperitoneal disease, and liver 1 08 if the correct sequences are performed. The EAU recommends a pelvic CT for positive inguinal nodes and an abdominal CT for positive pelvic nodes, though we perform a CT of abdomen and pelvis in all cases of node-positive disease. In either case, unless there is a high clinical suspicion, a plain chest radiograph is adequate, rather than CT.1 If there is symptomatic bone pain or pathological fracture, a bone scan may be used to delineate metastases,1 although CT can provide more anatomical information, and there is emerging evidence that MRI (using STIR sequences) may be as effective as bone scan in the detection of bony metastases.109

If performed for pelvic staging, a combined PET/CT scan is likely to be a sensitive test for abdominal, chest, and bone metastases given the high uptake of the primary tumor.77

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