J Korean Med Assoc.  2015 Jan;58(1):7-14. 10.5124/jkma.2015.58.1.7.

Medical imaging of prostate cancer

• Lee HJ

• KMID: 2149277
• DOI: http://doi.org/10.5124/jkma.2015.58.1.7

Abstract

The clinical significance of prostate cancer is increasing markedly with an increased population of aged persons and Westernized behavior patterns. Accordingly, the role of prostate imaging is also becoming important in the early diagnosis of prostate cancer. Transrectal prostate ultrasound (TRUS) is used for the estimation of prostate volume as well as the detection of prostate cancer, seen as focal hypoechoic lesions. Almost all prostate tissue biopsies are performed under the guidance of TRUS. One of the important issues in prostate imaging is the visualization of suspected prostate cancer lesions. In order to obtain detailed information regarding a suspected prostate lesion, contrast-enhanced imaging is utilized, using microbubbles and elastography. In addition, magnetic resonance imaging-ultra sonography (MRI-US) fusion imaging, in which the ultrasound machine archives magnetic resonance (MR) images and facilitates MRI-US fusion imaging-guided biopsy, has been revealed to be superior to conventional ultrasound-guided biopsy. Prostate MR is usually performed in patients with confirmed prostate cancer, after prostate biopsy for the evaluation of tumor staging or follow-up changes after chemotherapy, hormone therapy, or radiation therapy. In particular, the evaluation of seminal vesicles is crucial for accurate identification of tumor staging. Advanced functional MR techniques, including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy, also have potential in the localization of prostate cancer. In summary, the role of prostate imaging in the diagnosis and localization of prostate cancer is increasing. Advanced technologies in ultrasound and MR imaging may have important roles in localization of prostate cancer and image-guided biopsy.

Keyword

Prostate; Ultrasonography; Magnetic resonance imaging; Biopsy; Image fusion

MeSH Terms

Biopsy
Diagnosis
Diagnostic Imaging*
Drug Therapy
Early Diagnosis
Elasticity Imaging Techniques
Follow-Up Studies
Humans
Image-Guided Biopsy
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Microbubbles
Neoplasm Staging
Prostate
Prostatic Neoplasms*
Seminal Vesicles
Ultrasonography

Figure

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  Figure 1 Transrectal ultrasound of benign prostate hyperplasia. Transrectal ultrasound of 69-year-old man shows relatively well defined low echoic area suggesting benign prostate hyperplasia (arrows).

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  Figure 2 Transrectal ultrasound (TRUS) of prostate cancer involving left peripheral zone of prostate. TRUS of 71-year-old man shows well defined low echoic area involving left peripheral zone of prostate. Pathologic report after TRUS guided biopsy revealed that prostate cancer with Gleason score of 7 (4+3).

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  Figure 3 Schematic drawing of focal lesion seen on transrectal ultrasound (TRUS). The figure shows algorithm for the evaluation of suspicious focal lesion seen on TRUS. The diagram suggested four criteria including nodular shape, irregular outline, increased vascularity, and peripheral location for the suspicion of prostate cancer.

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  Figure 4 Increased vascularity of prostate cancer on transrectal ultrasound. Power Doppler image of 65-year-old man shows increased vascularity on low echoic lesion on left peripheral zone of prostate.

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  Figure 5 Magnetic resonance imaging finding of prostate cancer. T2 weighted axial image of 65-year-old man shows low signal intensity of left peripheral zone. Also note contour bulging of this lesion suggesting periprostatic invasion (arrows).

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  Figure 6 Magnetic resonance imaging finding of seminal vesicle invasion in prostate cancer. T2 weighted axial scan reveals definite low signal intensity mass involving whole seminal vesicle (arrows).

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  Figure 7 Diffusion weighted image of prostate cancer. (A) T2 weighed axial scan shows suspicious ill- defined low signal intensity area in anterior transitional zone (arrows). (B) Apparent diffusion coefficient map of same patient reveals that definite low signal in same area. Pathologic report after prostatectomy reveals prostate cancer was in same area.

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  Figure 8 Elastography of prostate cancer. Elastography of 75-year-old man shows the difference of elasticity between area 1 and area 2. Targeted biopsy on area 2 revealed prostate cancer with Gleason score of 7 (4+3). E1_b, elasticity on 1 area; E2_b, elasticity on 2 area; E2/E1, elasticity ratio.

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  Figure 9 Magnetic resonance imaging-ultrasonography fusion image of prostate cancer. (A) apparent diffusion coefficient map of 68-year-old man with history of negative transrectal ultrasound guided biopsy results showed definite signal drop on anterior area of prostate, which suggest prostate cancer on this area. (B) Magnetic resonance imaging-ultrasonography fusion image guided biopsy was performed on this area and the pathologic report revealed that prostate cancer with Gleason score of 8 (4+4).

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