Contemporary Review of Multimodality Imaging of the Prostate Gland

Abstract

Tissue changes and the enlargement of the prostate, whether benign or malignant, are among the most common groups of diseases that affect men and can have significant impacts on length and quality of life. The prevalence of benign prostatic hyperplasia (BPH) increases significantly with age and affects nearly all men as they grow older. Other than skin cancers, prostate cancer is the most common cancer among men in the United States. Imaging is an essential component in the diagnosis and management of these conditions. Multiple modalities are available for prostate imaging, including several novel imaging modalities that have changed the landscape of prostate imaging in recent years. This review will cover the data relating to commonly used standard-of-care prostate imaging modalities, advances in newer technologies, and newer standards that impact prostate gland imaging.

Keywords: benign prostatic hyperplasia; prostate cancer; prostatic adenocarcinoma.

Figure 1

Axial CT image of the pelvis following the administration of intravenous contrast demonstrates focal asymmetric enhancement of the left seminal vesicle, subsequently found to represent prostate cancer at the time of biopsy.

Figure 2

Axial T2 (A), diffusion-weighted b2000 (B), apparent diffusion coefficient (C), and dynamic contrast-enhanced (D) images of the pelvis demonstrating a focal ill-defined T2 hypointense lesion in the right midgland posterolateral peripheral zone with corresponding diffusion restriction and asymmetric enhancement, characterized as PI-RADS 5 per PI-RADS v2.1.

Figure 3

Whole-body maximum intensity projection (A), axial fused fluiclovine-PET/MRI (B), axial T2 (C), diffusion-weighted b2000 (D), apparent diffusion coefficient (E), and dynamic contrast-enhanced (F) images demonstrating focal uptake of radiotracer in the right prostatic apex peripheral zone with corresponding MR defined T2 hypointense lesion with associated restricted diffusion and focal asymmetric enhancement (PI-RADS 5), consistent with prostate cancer.

Figure 4

Graphical illustration of the transurethral resection of the prostate procedure. https://nci-media.cancer.gov/pdq/media/images/442342.jpg (accessed on 10 March 2023).

Figure 5

Sagittal T2 image demonstrating post-TURP changes of the prostate. Note the central defect at the level of the prostatic urethra and the relative absence of a median lobe.

Figure 6

Sagittal T2 image demonstrating post-HoLEP changes to the prostate. As compared to TURP, HoLEP features a wider central defect with less residual peripheral tissue.

Figure 7

Coronal CT appearance of UroLift device indicated by linear densities within the bilateral prostate gland.

Figure 8

Sagittal T2 image of the pelvis demonstrating a complete absence of the prostate gland with vesicourethral anastomosis following RP.

Figure 9

Axial (A), coronal (B), and sagittal (C) T2 images of the irradiated prostate, which demonstrate the loss of features and typical demarcation as well as overall T2 hypointensity, comparable to fibrosis expected post treatment.

Figure 10

Post-HIFU ablation defect seen on axial T2 MRI as asymmetric atrophy with adjacent fibrosis and architectural distortion, predominantly involving the right hemigland.