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Magnetic resonance imaging and magnetic resonance spectroscopic imaging of prostate cancer

Nature Clinical Practice Urology volume 2, pages 434–442 (2005)Cite this article

Abstract

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) are evolving techniques that offer noninvasive evaluation of anatomic and metabolic features of prostate cancer. The ability of MRI to determine the location and extent of the tumor and to identify metastatic spread is useful in the pretreatment setting, enabling treatment decision-making that is evidence-based. MRSI of the prostate gland expands the diagnostic assessment of prostate cancer through the detection of cellular metabolites, and can lead to noninvasive differentiation of cancer from healthy tissue. MRI/MRSI can also be used to evaluate both local and systemic recurrence, with endorectal MRI being capable of detecting local recurrence, even in patients with rising serum PSA level but no palpable tumor on digital rectal examination. Considering the benefits that MRI and MRSI have been shown to offer patients, the skills and technology required to perform these tests should be widely disseminated to make their routine use possible. Teamwork between members of radiology, pathology, urology and radiation oncology departments is essential in order to exploit these technologies fully.

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Figure 1: A 57-year-old male with Gleason score 6, pT2b prostate cancer.
Figure 2: Biopsy-proven Gleason score 8 adenocarcinoma in a 58-year-old man with a serum PSA level of 8.5 ng/ml.
Figure 3: Biopsy-proven Gleason score 8 adenocarcinoma in a 59-year-old man with a PSA level of 25 ng/ml.
Figure 4: Biopsy-proven Gleason score 8 adenocarcinoma in a 46-year-old man with a PSA level of 4 ng/ml.
Figure 5: T2-weighted (A) axial, (B) sagittal and (C) coronal images of an 87-year-old man with increasing PSA levels after radical prostatectomy for a Gleason score 8 adenocarcinoma of the prostate.

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References

  1. Jemal A et al. (2005) Cancer statistics, 2005. CA Cancer J Clin 55: 10–30

    Article  Google Scholar 

  2. Boring CC et al. (1993) Cancer statistics, 1993. CA Cancer J Clin 43: 7–26

    Article  CAS  Google Scholar 

  3. Amling CL et al. (1998) Influence of prostate-specific antigen testing on the spectrum of patients with prostate cancer undergoing radical prostatectomy at a large referral practice. Mayo Clin Proc 73: 401–406

    Article  CAS  Google Scholar 

  4. Stamey TA et al. (1998) Classification of localized untreated prostate cancer based on 791 men treated only with radical prostatectomy: common ground for therapeutic trials and TNM subgroups. J Urol 159: 2009–2012

    Article  CAS  Google Scholar 

  5. Kaminski JM et al. (2002) Relationship between prostate volume, prostate-specific antigen nadir, and biochemical control. Int J Radiat Oncol Biol Phys 52: 888–892

    Article  Google Scholar 

  6. Zelefsky MJ et al. (2001) High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 166: 876–881

    Article  CAS  Google Scholar 

  7. Beyersdorff D et al. (2002) Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: value of MR imaging. Radiology 224: 701–706

    Article  Google Scholar 

  8. Yuen JS et al. (2004) Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy. J Urol 171: 1482–1486

    Article  CAS  Google Scholar 

  9. Claus FG et al. (2004) Pretreatment Evaluation of Prostate Cancer: Role of MR Imaging and 1H MR Spectroscopy. Radiographics 24 (Suppl 1): S167–S180

    Article  Google Scholar 

  10. Hricak H et al. (2003) Advances in imaging in the postoperative patient with a rising prostate-specific antigen level. Semin Oncol 30: 616–634

    Article  Google Scholar 

  11. Hricak H et al. (1994) Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils versus integrated endorectal—pelvic phased-array coils. Radiology 193: 703–709

    Article  CAS  Google Scholar 

  12. Coakley FV and Hricak H (2000) Radiologic anatomy of the prostate gland: a clinical approach. Radiol Clin North Am 38: 15–30

    Article  CAS  Google Scholar 

  13. Hricak H et al. (1987) MR imaging of the prostate gland: normal anatomy. AJR Am J Roentgenol 148: 51–58

    Article  CAS  Google Scholar 

  14. Noguchi M et al. (2000) An analysis of 148 consecutive transition zone cancers: clinical and histological characteristics. J Urol 163: 1751–1755

    Article  CAS  Google Scholar 

  15. Perrotti M et al. (1999) Prospective evaluation of endorectal magnetic resonance imaging to detect tumor foci in men with prior negative prostastic biopsy: a pilot study. J Urol 162: 1314–1317

    Article  CAS  Google Scholar 

  16. Fleshner NE and Fair WR (1997) Indications for transition zone biopsy in the detection of prostatic carcinoma. J Urol 157: 556–558

    Article  Google Scholar 

  17. Liu IJ et al. (2001) Critical evaluation of the current indications for transition zone biopsies. Urology 57: 1117–1120

    Article  CAS  Google Scholar 

  18. Engelbrecht MR et al. (2003) Discrimination of prostate cancer from normal peripheral zone and central gland tissue by using dynamic contrast-enhanced MR imaging. Radiology 229: 248–254

    Article  Google Scholar 

  19. van Dorsten FA et al. (2004) Combined quantitative dynamic contrast-enhanced MR imaging and (1)H MR spectroscopic imaging of human prostate cancer. J Magn Reson Imaging 20: 279–287

    Article  Google Scholar 

  20. Ogura K et al. (2001) Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. Urology 57: 721–726

    Article  CAS  Google Scholar 

  21. Scheidler J et al. (1999) Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging—clinicopathologic study. Radiology 213: 473–480

    Article  CAS  Google Scholar 

  22. Kurhanewicz J et al. (1996) Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24–0.7-cm3) spatial resolution. Radiology 198: 795–805

    Article  CAS  Google Scholar 

  23. Heerschap A et al. (1997) In vivo proton MR spectroscopy reveals altered metabolite content in malignant prostate tissue. Anticancer Res 17: 1455–1460

    CAS  PubMed  Google Scholar 

  24. Zakian KL et al. (2005) Correlation of proton MR spectroscopic imaging with Gleason score based on step section pathologic analysis after radical prostatectomy. Radiology 234: 804–814

    Article  Google Scholar 

  25. Kaji Y et al. (1998) Localizing prostate cancer in the presence of postbiopsy changes on MR images: role of proton MR spectroscopic imaging. Radiology 206: 785–790

    Article  CAS  Google Scholar 

  26. Schiebler ML et al. (1993) Current role of MR imaging in the staging of adenocarcinoma of the prostate. Radiology 189: 339–352

    Article  CAS  Google Scholar 

  27. Heerschap A et al. (1997) Proton MR spectroscopy of the normal human prostate with an endorectal coil and a double spin-echo pulse sequence. Magn Reson Med 37: 204–213

    Article  CAS  Google Scholar 

  28. Coakley FV et al. (2002) Prostate cancer tumor volume: measurement with endorectal MR and MR spectroscopic imaging. Radiology 223: 91–97

    Article  Google Scholar 

  29. Kurhanewicz J et al. (2000) The prostate: MR imaging and spectroscopy. Present and future. Radiol Clin North Am 38: 115–138, viii–ix

    Article  CAS  Google Scholar 

  30. Mullerad M et al.: Comparison of endorectal magnetic resonance imaging, guided prostate biopsy and digital rectal examination in the preoperative anatomical localization of prostate cancer. J Urol, in press

  31. D'Amico AV et al. (2000) Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localized prostate cancer. J Urol 164: 759–763

    Article  CAS  Google Scholar 

  32. Jager GJ et al. (2000) Prostate cancer staging: should MR imaging be used?—A decision analytic approach. Radiology 215: 445–451

    Article  CAS  Google Scholar 

  33. Yu KK et al. (1999) Prostate cancer: prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology 213: 481–488

    Article  CAS  Google Scholar 

  34. Engelbrecht MR et al. (2002) Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur Radiol 12: 2294–2302

    Article  Google Scholar 

  35. Wang L et al. (2004) Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. Radiology 232: 133–139

    Article  Google Scholar 

  36. Yu KK et al. (1997) Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology 202: 697–702

    Article  CAS  Google Scholar 

  37. Mullerad M et al. (2004) Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging. Radiology 232: 140–146

    Article  Google Scholar 

  38. Hull GW et al. (2002) Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 167: 528–534

    Article  Google Scholar 

  39. Catalona WJ et al. (1999) Contemporary results of anatomic radical prostatectomy. CA Cancer J Clin 49: 282–296

    Article  CAS  Google Scholar 

  40. Bernstein MR et al. (2000) Endorectal coil magnetic resonance imaging and clinicopathologic findings in T1c adenocarcinoma of the prostate. Urol Oncol 5: 104–107

    Article  CAS  Google Scholar 

  41. Naya Y et al. (2003) Volume indexes of total, free, and complexed prostate-specific antigen enhance prediction of extraprostatic disease extension in men with nonpalpable prostate cancer. Urology 62: 1058–1062

    Article  Google Scholar 

  42. Wymenga LF et al. (2001) Routine bone scans in patients with prostate cancer related to serum prostate-specific antigen and alkaline phosphatase. BJU Int 88: 226–230

    Article  CAS  Google Scholar 

  43. Harisinghani MG et al. (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348: 2491–2499

    Article  Google Scholar 

  44. Bellin MF et al. (1998) Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles—initial clinical experience. Radiology 207: 799–808

    Article  CAS  Google Scholar 

  45. Hovels AM et al. (2004) Cost-analysis of staging methods for lymph nodes in patients with prostate cancer: MRI with a lymph node-specific contrast agent compared to pelvic lymph node dissection or CT. Eur Radiol 14: 1707–1712

    Article  Google Scholar 

  46. Daldrup-Link HE et al. (2001) Whole-Body MR Imaging for Detection of Bone Metastases in Children and Young Adults. AJR Am J Roentgenol 177: 229–236

    Article  CAS  Google Scholar 

  47. Algra PR et al. (1991) Detection of vertebral metastases: comparison between MR imaging and bone scintigraphy. Radiographics 11: 219–232

    Article  CAS  Google Scholar 

  48. Turner JW et al. (1993) Magnetic resonance imaging for detection of prostate cancer metastatic to bone. J Urol 149: 1482–1484

    Article  CAS  Google Scholar 

  49. Eustace S et al. (1997) A comparison of whole-body turboSTIR MR imaging and planar 99mTc-methylene diphosphonate scintigraphy in the examination of patients with suspected skeletal metastases. AJR Am J Roentgenol 169: 1655–1661

    Article  CAS  Google Scholar 

  50. Meijer WG et al. (2003) Bone metastases in carcinoid tumors: clinical features, imaging characteristics, and markers of bone metabolism. J Nucl Med 44: 184–191

    PubMed  Google Scholar 

  51. Traill ZC et al. (1999) Magnetic resonance imaging versus radionuclide scintigraphy in screening for bone metastases. Clin Radiol 54: 448–451

    Article  CAS  Google Scholar 

  52. Lauenstein TC et al. (2004) Whole-body MR imaging: evaluation of patients for metastases. Radiology 233: 139–148

    Article  Google Scholar 

  53. Lauenstein TC et al. (2002) Three-dimensional volumetric interpolated breath-hold MR imaging for whole-body tumor staging in less than 15 minutes: a feasibility study. AJR Am J Roentgenol 179: 445–449

    Article  Google Scholar 

  54. Silverman JM and Krebs TL (1997) MR imaging evaluation with a transrectal surface coil of local recurrence of prostatic cancer in men who have undergone radical prostatectomy. AJR Am J Roentgenol 168: 379–385

    Article  CAS  Google Scholar 

  55. Sella T et al. (2004) Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 231: 379–385

    Article  Google Scholar 

  56. Nudell DM et al. (2000) Imaging for recurrent prostate cancer. Radiol Clin North Am 38: 213–229

    Article  CAS  Google Scholar 

  57. Coakley FV et al. (2004) Endorectal MR imaging and MR spectroscopic imaging for locally recurrent prostate cancer after external beam radiation therapy: preliminary experience. Radiology 233: 441–448

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. the Department of Radiology, University Hospital Dubrava, Zagreb, Croatia

    Renata Huzjan

  2. University Lecturer in Oncology Imaging in the Department of Radiology, University of Cambridge, Cambridge, UK

    Evis Sala

  3. Chairman of the Department of Radiology of Memorial Sloan-Kettering Cancer Center and Professor of Radiology, Weill Medical College of Cornell University, New York, NY, USA

    Hedvig Hricak

Authors
  1. Renata Huzjan
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  2. Evis Sala
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  3. Hedvig Hricak
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Correspondence to Hedvig Hricak.

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Huzjan, R., Sala, E. & Hricak, H. Magnetic resonance imaging and magnetic resonance spectroscopic imaging of prostate cancer. Nat Rev Urol 2, 434–442 (2005). https://doi.org/10.1038/ncpuro0296

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