Imaging of Prostate Cancer
Section snippets
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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2019, Ultrasound in Medicine and BiologyDetection of recurrent prostate cancer after primary radiation therapy: An evaluation of the role of multiparametric 3T magnetic resonance imaging with endorectal coil
2017, Practical Radiation OncologyCitation Excerpt :The use of MRI after RT is not performed routinely in patients unless they exhibit findings suggestive of recurrence such as a rising PSA or abnormal digital rectal exam. Because radiation may cause substantial changes to the tissues, including glandular atrophy and fibrosis, loss of normal zonal anatomy, and inconsistent thickening of the capsule, the ability of T2-weighted imaging to detect and define intraprostatic lesions after radiation may be limited.19,20 In addition, the metallic seeds used in brachytherapy can also lead to some distortion of image quality, particularly affecting diffusion weighted imaging; however, in our series, the presence of permanent brachytherapy sources did not appear to affect the diagnostic performance.
State-of-the-art imaging of prostate cancer
2016, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Several meta-analyses have shown a sensitivity ranging from 74% to 82% and a specificity ranging from 68% to 88% [32,33]. The NPV of mp-MRI has been shown to range from 65% to 94% [33]. However, mp-MRI has been shown to be less sensitive for the detection of Gleason 6 disease or small tumors less than 0.1 cm3 [29].
Prognostic utility of PET in prostate cancer
2015, PET ClinicsCitation Excerpt :They also submit rightfully that in this perplexing situation, incorporation of the newly emerging biomarkers, including imaging results, can add significant direct information about the tumor, which can then enhance the model’s predictive power in comparison to the traditional use of clinical and pathologic parameters. Imaging plays an important current and expanding role in the imaging evaluation of every phase of the natural history of prostate cancer.60 Given the limitations of the current prediction tools, newer biomarkers, including circulating tumor cells, patient-reported outcomes, and imaging are of much interest for monitoring of clinical outcomes in specific groups of patients with prostate cancer.61