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Prostate Cancer Detection and Diagnosis: The Role of MR and its Comparison with Other Diagnostic Modalities - A Radiologist's Perspective

Institution:
Division of MRI and Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Publisher:
John Wiley & Sons, Inc.
Publication Date:
Jan-2014
Journal:
NMR Biomed
Volume Number:
27
Issue Number:
1
Pages:
3-15
Citation:
NMR Biomed. 2014 Jan;27(1):3-15.
PubMed ID:
24000133
PMCID:
PMC3851933
Keywords:
MR elastography (MRE), Diffusion Weighted MRI, dynamic contrast enhancement (DCE) imaging, Post Acquisition Processing, prostate MRI, prostate cancer
Appears in Collections:
Prostate Group, NCIGT, SLICER, SPL
Sponsors:
P01 CA067165/CA/NCI NIH HHS/United States
R01 CA111288/CA/NCI NIH HHS/United States
P41 EB015898/EB/NIBIB NIH HHS/United States
P41 RR019703/RR/NCRR NIH HHS/United States
U54 EB005149/EB/NIBIB NIH HHS/United States
U01 CA151261/CA/NCI NIH HHS/United States
Generated Citation:
Penzkofer T., Tempany C.M. Prostate Cancer Detection and Diagnosis: The Role of MR and its Comparison with Other Diagnostic Modalities - A Radiologist's Perspective. NMR Biomed. 2014 Jan;27(1):3-15. PMID: 24000133. PMCID: PMC3851933.
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It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer from 2009 evidenced that, to save one man from death from prostate cancer, over 1400 men need to be screened, and 48 need to undergo treatment. The detection of prostate cancer is traditionally based on digital rectal examination (DRE) and the measurement of serum prostate-specific antigen (PSA), followed by ultrasound-guided biopsy. The primary role of imaging for the detection and diagnosis of prostate cancer has been transrectal ultrasound (TRUS) guidance during biopsy. Traditionally, MRI has been used primarily for the staging of disease in men with biopsy-proven cancer. It has a well-established role in the detection of T3 disease, planning of radiation therapy, especially three-dimensional conformal or intensity-modulated external beam radiation therapy, and planning and guiding of interstitial seed implant or brachytherapy. New advances have now established that prostate MRI can accurately characterize focal lesions within the gland, an ability that has led to new opportunities for improved cancer detection and guidance for biopsy. Two new approaches to prostate biopsy are under investigation. Both use pre-biopsy MRI to define potential targets for sampling, and the biopsy is performed either with direct real-time MR guidance (in-bore) or MR fusion/registration with TRUS images (out-of-bore). In-bore and out-of-bore MRI-guided prostate biopsies have the advantage of using the MR target definition for the accurate localization and sampling of targets or suspicious lesions. The out-of-bore method uses combined MRI/TRUS with fusion software that provides target localization and increases the sampling accuracy of TRUS-guided biopsies by integrating prostate MRI information with TRUS. Newer parameters for each imaging modality, such as sonoelastography or shear wave elastography, contrast-enhanced ultrasound and MRI elastography, show promise to further enrich datasets.

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