In their lifetime, 1 in 6 men will be clinically diagnosed with prostate cancer. If serum prostate specific antigen (PSA) is elevated or digital rectal exam suggests a tumor, transrectal ultrasound-guided biopsy may be performed to detect potential cancer, and assess its extent, volume and aggressiveness. But the specificity of PSA is low, and TRUS biopsy underestimates the extent and grade of prostate cancer. MRI has a role in detecting and staging prostate carcinoma, and in evaluating men with a rising PSA after therapy.

A dedicated team of radiologists and MRI physicists at Stanford have optimized prostate cancer MRI techniques on state-of-the-art scanners, and continually ensure integration of the latest technological advances.

Sample Epic Order (click image to enlarge)

EPIC order for dedicated prostate MR at 3T, for local staging and evaluation after resection, radiation or hormonal therapy. EPIC order for regional abdomen/pelvis staging evaluation of prostate cancer.

Examples (click on images)

Prostate cancer, Gleason 4+4.Patient had prior negative biopsy and high PSA, however there were TZ lesions seen in MRI. The MRIs were useful in directing successful rebiopsy showing cancer.Patient had prior negative biopsy and high PSA, however there were TZ lesions seen in MRI with Gleason 4 and 5. Again, the MRIs were useful in directing successful rebiopsy showing cancer.Patient had prior negative biopsy and high PSA, however there were TZ lesions seen in MRI with Gleason 4 and 5. Again, the MRIs were useful in directing successful rebiopsy showing cancer.Patient had only a mildly elevated PSA, but there was a big anterior tumor on the left. Again, the MRIs were useful in active surveillance of prostate cancer.Patient had only a mildly elevated PSA, but there was a big anterior tumor on the left. Again, the MRIs were useful in active surveillance of prostate cancer.

References

  1. Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22:746-757. PubMed link
  2. Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics 2011; 31:677-703. PubMed link
  3. Claus FG, Hricak H, Hattery RR. Pretreatment evaluation of prostate cancer: role of MR imaging and 1H MR spectroscopy. Radiographics 2004; 24 Suppl 1:S167-180. PubMed link
  4. De Visschere PJ, De Meerleer GO, Futterer JJ, Villeirs GM. Role of MRI in follow-up after focal therapy for prostate carcinoma. AJR Am J Roentgenol 2010; 194:1427-1433. PubMed link
  5. Langer DL, van der Kwast TH, Evans AJ, Trachtenberg J, Wilson BC, Haider MA. Prostate cancer detection with multi-parametric MRI: logistic regression analysis of quantitative T2, diffusion-weighted imaging, and dynamic contrast-enhanced MRI. J Magn Reson Imaging 2009; 30:327-334. PubMed link
  6. Mazaheri Y, Hricak H, Fine SW, et al. Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. Radiology 2009; 252:449-457. PubMed link
  7. Vargas HA, Akin O, Franiel T, et al. Diffusion-weighted endorectal MR imaging at 3 T for prostate cancer: tumor detection and assessment of aggressiveness. Radiology 2011; 259:775-784. PubMed link
  8. Vargas HA, Wassberg C, Akin O, Hricak H. MR imaging of treated prostate cancer. Radiology 2012; 262:26-42. PubMed link

Last modified Tue, 24 Sep, 2013 at 9:37