Imaging localized prostate cancer: current approaches and new developments

Abstract

Objective: Prostate cancer is the most common noncutaneous malignancy among men in the Western world. Imaging has recently become more important in the diagnosis, local staging, and treatment follow-up of prostate cancer. In this article, we review conventional and functional imaging methods as well as targeted imaging approaches with novel tracers used in the diagnosis and staging of prostate cancer.

Conclusion: Although prostate cancer is the second leading cause of cancer death in men, imaging of localized prostate cancer remains limited. Recent developments in imaging technologies, particularly MRI and PET, may lead to significant improvements in lesion detection and staging.

Fig. 1. 54-year-old man with increased serum prostate-specific antigen

A, Axial T2-weighted image shows normal peripheral zone (P), which is hyperintense compared with central gland (C) and is separated by pseudocapsule (arrowheads); true capsule of prostate is seen as hypointense rim (solid arrows) with neurovascular bundles (dashed arrows). B, Axial T2-weighted image shows normal seminal vesicles (arrows) posterior to base of urinary bladder.

Fig. 2

Graph shows estimated summary receiver operating characteristic curve for data obtained from T2-weighted MRI studies with whole-mount step-section histopathology correlation. Estimated area under curve is 0.78. This curve shows approximate trade-off between sensitivity and specificity.

Fig. 3. 61-year-old man with prostate cancer

A, Axial T2-weighted image shows round low-signal-intensity lesion (arrow) at right base peripheral zone. B and C, Lesion (arrow) appears as bright and dark on corresponding raw diffusion-weighted (B) and apparent diffusion coefficient map (C) images, respectively. D, MR spectroscopy image shows increased choline-to-citrate ratio (insets) within right peripheral zone lesion compared with normal left side. Choline = cho, cit = citrate.

Fig. 4

Graph shows estimated summary receiver operating characteristic curve for data obtained from MR spectroscopy studies with whole-mount step- section histopathology correlation. Estimated area under curve is 0.82.

Fig. 5. 51-year-old man with prostate cancer

A, Axial T2-weighted MR image shows low-signal-intensity focus (arrow) at right mid peripheral zone. B, Lesion (arrow) shows increased enhancement on axial T1-weighted dynamic contrast-enhanced MR image. C and D, Fusion of color-coded forward volume transfer constant (C) and reverse reflux rate constant (D) maps delineates tumor (arrows).

Fig. 6

Graph shows estimated summary receiver operating characteristic curve for data obtained from dynamic contrast-enhanced MRI studies with whole-mount step-section histopathology correlation. Estimated area under curve is 0.91.