Imaging and intervention in prostate cancer: Current perspectives and future trends

Abstract

Prostate cancer is the commonest malignancy in men that causes significant morbidity and mortality worldwide. Screening by digital rectal examination (DRE) and serum prostate-specific antigen (PSA) is used despite its limitations. Gray-scale transrectal ultrasound (TRUS), used to guide multiple random prostatic biopsies, misses up to 20% cancers and frequently underestimates the grade of malignancy. Increasing the number of biopsy cores marginally increases the yield. Evolving techniques of real-time ultrasound elastography (RTE) and contrast-enhanced ultrasound (CEUS) are being investigated to better detect and improve the yield by allowing “targeted” biopsies. Last decade has witnessed rapid developments in magnetic resonance imaging (MRI) for improved management of prostate cancer. In addition to the anatomical information, it is capable of providing functional information through diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and dynamic contrast-enhanced (DCE) MRI. Multi-parametric MRI has the potential to exclude a significant cancer in majority of cases. Inclusion of MRI before prostatic biopsy can reduce the invasiveness of the procedure by limiting the number of cores needed to make a diagnosis and support watchful waiting in others. It is made possible by targeted biopsies as opposed to random. With the availability of minimally invasive therapeutic modalities like high-intensity focused ultrasound (HIFU) and interstitial laser therapy, detecting early cancer is even more relevant today. [18F]--fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) has no role in the initial evaluation of prostate cancer. Choline PET has been recently found to be more useful. Fluoride-PET has a higher sensitivity and resolution than a conventional radionuclide bone scan in detecting skeletal metastases.

Role of transrectal ultrasound elastography in the diagnosis of prostate carcinoma

“…However, benign lesions like prostatitis can also show increased flow on CD and CD does not reveal microscopic vessels of prostatic cancer that do not possess enough flow to cause Doppler shift. [ 25 26 ] Despite these limitations, our findings indicate that CD imaging can be a useful adjunct to improve tumor detection by TRUS.…”

Integration of Metabolomics and Transcriptomics Reveals Major Metabolic Pathways and Potential Biomarker Involved in Prostate Cancer

“…Sphingosine is the substrate for sphingosine kinase to generate sphingosine-1-phosphate (S1P), which subsequently binds to a family of five G protein-coupled receptors, termed S1PR [1][2][3][4][5] (Fig. 5H).…”

“…We also found impaired sphingosine-1-phosphate receptor 2 signaling, downstream of sphingosine, representing a loss of tumor suppressor gene and a potential key oncogenic pathway for therapeutic targeting. By integrating metabolomics and transcriptomics, we have provided both a broad picture of the molecular perturbations underlying prostate cancer and a preliminary study of a novel metabolic signature, which may help to discriminate prostate cancer from normal tis- Prostate cancer (PCa) 1 is the most commonly diagnosed visceral malignancy among men and the second leading cause of cancer-related death in Western countries, second only to lung cancer (1,2). The prevalence of PCa in Asian populations, such as China and Japan, was much lower than Western countries, but its incidence and associated mortality rates are increasing rapidly with the growing aging population (3).…”

Prostate cancer diagnostics: Clinical challenges and the ongoing need for disruptive and effective diagnostic tools

“…While immunoassays are highly sensitive and selective techniques, they are very time consuming and labour-intensive. Other techniques for cancer diagnosis include digital rectal examination and biopsy, are very invasive methods (Sharma, 2014). Recently, new genomic and proteomics techniques have been employed to generate molecular signatures of prostate cancer (Varambally et al, 2005;Myers et al, 2015).…”