Imaging Prostate Cancer: A Multidisciplinary Perspective

Abstract

The major goal for prostate cancer imaging in the next decade is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. No consensus exists regarding the use of imaging for evaluating primary prostate cancers. Ultrasonography is mainly used for biopsy guidance and brachytherapy seed placement. Endorectal magnetic resonance (MR) imaging is helpful for evaluating local tumor extent, and MR spectroscopic imaging can improve this evaluation while providing information about tumor aggressiveness. MR imaging with superparamagnetic nanoparticles has high sensitivity and specificity in depicting lymph node metastases, but guidelines have not yet been developed for its use, which remains restricted to the research setting. Computed tomography (CT) is reserved for the evaluation of advanced disease. The use of combined positron emission tomography/CT is limited in the assessment of primary disease but is gaining acceptance in prostate cancer treatment follow-up. Evidence-based guidelines for the use of imaging in assessing the risk of distant spread of prostate cancer are available. Radionuclide bone scanning and CT supplement clinical and biochemical evaluation (prostate-specific antigen [PSA], prostatic acid phosphate) for suspected metastasis to bones and lymph nodes. Guidelines for the use of bone scanning (in patients with PSA level > 10 ng/mL) and CT (in patients with PSA level > 20 ng/mL) have been published and are in clinical use. Nevertheless, changes in practice patterns have been slow. This review presents a multidisciplinary perspective on the optimal role of modern imaging in prostate cancer detection, staging, treatment planning, and follow-up.

Prostate cancer - the role of magnetic resonance imaging

“…MR imaging has been reported to have a 13%-95% sensitivity and 49%-97% specificity for detection of extracapsular extension (ref. 1 ). The gold standard in 1.5 T MR system for imaging of prostate cancer is dual examination with integrate pelvic phased-array/endorectal phased array.…”

“…In 3.0T MR the recent advances with faster imaging sequences, more powerful gradient coils, post-processing correction are able to exclude using the endorectal coil, surface phased-array coil is equivalent to endorectal coil in 3.0 T system 8,9 . However, it is expected, though not yet proven that the use of an endorectal coil at 3.0 T will allow better prostate cancer detection 1 . A surface phased-array coil MRI accurately stages prostate cancer with elevated risk of extraprostatic disease.…”

“…DCE-MRI has been shown to have a sensitivity of 73% and specificity of 81%, and on the 3.0T system a sensitivity of 73% and specificity of 77% (ref. 1 ). Analysis of the dynamic contrast -enhanced MR imaging remains controversial and requires more studies from the various institutions.…”

“…The major goal for prostatic cancer (PC) imaging is more accurate disease characterization through the synthesis of anatomic, functional and molecular imaging information 1 . The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and slow natural progression and biological heterogeneity of the disease has made its management a complex and controversial issue.…”

18F-fluorocholine for prostate cancer imaging: a systematic review of the literature

“…3 Conventional imaging with transrectal ultrasound (TRUS), computed tomography (CT), high-resolution magnetic resonance imaging (HR-MRI), ProstaScint or prostate-specific membrane antigen (PSMA) imaging and bone scan have historically been modest at best in detecting and staging clinically localized PCa. 4,5 To address the limitations of existing imaging techniques in the diagnosis and staging of PCa, numerous imaging innovations have been developed: ultrasound Doppler alone or combined with micro-bubble contrast agent, three-dimensional stereotactic US (3D-US), higher-resolution 3 T MRI, endo-rectal coils MRI, dynamic contrast enhanced MRI (DCE-MRI), diffusion weighted MRI (DW-MRI) and MR spectroscopy (MRS), and lymph node imaging using sentinel lymph node detection and superparamagnetic nanoparticle techniques. [4][5][6][7] One imaging innovation that has proved useful for metabolic imaging of many cancers is positron emission tomography (PET) or combined positron emission tomographycomputed tomography (PET/CT) using 2-[ 18 F]fluoro-2-deoxyglucose ( 18 F-FDG).…”