Imaging in Prostate Cancer Diagnosis: Present Role and Future Perspectives

Abstract

Prostate cancer (PCa) remains a major health concern for the male population. Detection and primary diagnosis of PCa are based on digital rectal examination, serum prostate-specific antigen levels, and transrectal ultrasound (TRUS)-guided random biopsy. Moreover, the gold standard for detecting PCa, systematic biopsy, lacks sensitivity as well as grading accuracy. This review summarizes recent developments of ultrasonography modalities and functional magnetic resonance imaging (MRI) in the diagnosis of PCa. A comparison between the different methods is presented, including their clinical value and usefulness. It is concluded that innovative ultrasound techniques (including ultrasound contrast agents, 3-D and 4-D sonography, elastography and harmonic sonography) promise benefits in comparison to standard TRUS to accurately diagnose PCa. Promising advances have been made in the detection of PCa with multiparametric MRI. The combination of conventional and functional MRI techniques (including diffusion-weighted imaging, dynamic contrast-enhanced MRI, and MR spectroscopy) can provide information for differentiating PCa from noncancerous tissue and can be used for MRI-guided biopsies, especially in patients with persistent elevation of serum prostate-specific antigen and previous negative TRUS-guided biopsies. However, functional MRI technique and MRI-guided biopsy remain expensive and complex tools presenting inherent challenges.

Imaging in Prostate Cancer Staging: Present Role and Future Perspectives

“…The ratio of choline to citrate is related to the Gleason score, suggesting that MRSI may provide information about cancer aggressiveness. Integration of MRSI into routine prostate MRI practice has improved tumor detection rates in several studies [9,14,52] . Moreover, MRSI can help in the estimation of tumor volume which is considered, from histopathological studies, a significant predictor of extracapsular extension [32,53] .…”

“…This pattern is highly predictive of prostate cancer but is not pathognomonic. However, smaller and low grade tumors may not demonstrate abnormal enhancement on DCE-MRI and several benign conditions such as prostatitis and post biopsy hemorrhage can mimic tumors on DCE-MRI [52,57] . DCE-MRI can improve staging performance when used in conjunction with T 2 W images for less-experienced readers when compared to more-experienced readers [58] .…”

“…18 F-FDG PET did not give good results in local staging even if tracer uptake is higher in poorly differentiated tumors and higher PSA values [85] . 11 C-choline PET/TC, even if helpful in detecting primary prostate cancer [52] , demonstrated low sensitivity for the assessment of extraprostatic extension [86][87][88][89][90] ( table 2 ). Martorana et al [89] , comparing 11 Ccholine PET/TC with MRI for extraprostatic extension, showed a very low sensitivity (22 vs. 63%, p !…”

Sonoelastography for differential diagnosis between malignant and benign parotid lesions: a meta-analysis

“…Sonoelastography is an innovative diagnostic imaging tool that assesses tissue stiffness [8]. Since malignant tissues are generally stiffer than benign components, sonoelastography has been used in many organs, such as the breast, thyroid and prostate, for differential diagnosis between malignant and benign lesions [9][10][11][12][13][14]. Recently, numerous studies have been published on the role of sonoelastography for differentiating between malignant and benign parotid lesions.…”

Fusion Target Biopsy of the Prostate Using Real-Time Ultrasound and MR Images. A Multicenter RCT on Target Biopsy Techniques in the Diagnosis of Prostate Cancer

“…Development of multiparametric MRI (mpMRI) techniques has increased the detection of significant cancers and the sensitivity for the determination of its aggression [15][16][17][18][19][20][21][22]. Clinical guidelines advise performing an mpMRI when the clinical suspicion on prostate cancer persists despite prior negative TRUS biopsy results to investigate the possibility of ventrally located lesions [3,4].…”