Imaging of Prostate Cancer

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Screening

Prostate cancer screening is performed with DRE and measurement of serum PSA level. Since the advent of PSA screening, the incidence of prostate cancer has increased, but most prostate cancers are now diagnosed at an early stage.

There are certain limitations to PSA screening. PSA is not specific for prostate cancer and can be elevated in other conditions including benign prostatic hyperplasia, inflammation, trauma, and urinary retention. Although cancerous prostate tissue produces far more PSA

Diagnosis

Needle biopsy, which is often guided by TRUS, continues to be the “gold standard” for the diagnosis of prostate cancer. TRUS provides reasonably good–quality images of the prostate and adjacent structures and facilitates needle placement and tissue sampling.

The fact that prostate cancer is often a multifocal and heterogeneous disease makes diagnosis by biopsy difficult. Only a small amount of tissue is obtained with needle biopsy. Thus, sampling errors are common. Initial TRUS-guided biopsy

Tumor detection and staging

The TNM staging system is widely used to stage prostate cancer (Table 1) [9]. Although imaging techniques are sometimes useful in the detection of prostate cancer, their main use is in the staging of the disease. A combination of the currently available imaging modalities is usually necessary to help determine appropriate treatment strategies.

Capromab pendetide immunoscintigraphy

Capromab pendetide immunoscintigraphy is a murine monoclonal antibody that reacts with prostate membrane–specific antigen, which is highly expressed in prostate cancer. Immunoscintigraphy is accomplished by labeling the antibody with indium 111. After infusion of the antibody, whole-body planar and single-photon emission CT images are obtained. Capromab pendetide immunoscintigraphy can be used for the detecting lymph node metastases, the site of relapse in a patient who has a detectable PSA

Treatment planning

The therapeutic options for patients who have prostate cancer vary widely and include watchful waiting, androgen ablation (chemical or surgical castration), hormone therapy, radical surgery, and various forms of radiation therapy (brachytherapy, external beam irradiation). The choice of optimal treatment strategy in patients who have prostate cancer is patient specific and risk adjusted. The therapeutic goal is to maximize cancer control while minimizing the risks of complications. The optimal

Post-treatment follow-up

After treatment, patients who have prostate cancer are followed with periodic measurement of PSA levels and DRE. Imaging is necessary after treatment for clinically localized prostate cancer only if there are suspicious findings on DRE, PSA is elevated, or the patient has symptoms such as bone pain.

Summary

Imaging modalities are rapidly evolving to provide improved evaluation of prostate cancer. Our understanding of imaging criteria and experience in image interpretation are also growing. In addition to the traditional roles of imaging in prostate cancer (ie, localization and staging), extensive research is being done on metabolic imaging to predict cancer aggressiveness. Future directions in prostate cancer imaging include more precise patient stratification for different management options and

Acknowledgments

The authors thank Ada Muellner, BA, for her assistance in editing the manuscript.

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