Prostate Cancer Imaging: What We Already Know and What Is on the Horizon

HomeRadioGraphicsVol. 42, No. 4 PreviousNext Genitourinary ImagingFree AccessRadioGraphics FundamentalsProstate Cancer Imaging: What We Already Know and What Is on the HorizonDiego N. dos Santos , Natally Horvat, Adriano Basso Dias, Marcelo Mota, George Veloso Filho, Karla Schoen, Sangeet Ghai, Marcelo Queiroz, Publio VianaDiego N. dos Santos , Natally Horvat, Adriano Basso Dias, Marcelo Mota, George Veloso Filho, Karla Schoen, Sangeet Ghai, Marcelo Queiroz, Publio VianaAuthor AffiliationsFrom the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil (D.N.D.S., N.H., M.M., G.V.F., K.S., M.Q., P.V.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); and Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.D., S.G.).Address correspondence to D.N.D.S. (e-mail: [email protected]).Diego N. dos Santos Natally HorvatAdriano Basso DiasMarcelo MotaGeorge Veloso FilhoKarla SchoenSangeet GhaiMarcelo QueirozPublio VianaPublished Online:May 27 2022https://doi.org/10.1148/rg.210134MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.TEACHING POINTS■ CT is not as useful as MRI for evaluating the prostate. However, CT can be used to assess bone metastases and some nodal and distant metastases.■ PSMA PET is well established for evaluating biochemical recurrence, even in patients with low prostate-specific antigen levels. PET/MRI has improved sensitivity for detection of prostate cancer compared with mpMRI and has also shown interesting applications for cancer detection, primary staging, assessment of therapeutic response, and treatment planning.■ Radiomics studies continue to improve prognosis and therapeutic response prediction, paving the way for imaging-based precision medicine.In this online presentation, the clinical features and anatomic landmarks of prostate cancer are shown to review the roles of different imaging modalities in several clinical contexts, including screening, detection, staging, active surveillance, and biochemical recurrence, from conventional imaging methods that are currently the most used, to new modalities that lie ahead.The evolution of diagnostic imaging methods has contributed to a more accurate depiction of prostate cancer. Transrectal US (TRUS) has an important role in guiding systematic biopsies, but some tumors may be missed. CT is not as useful as MRI for evaluation of the prostate, but it can be used to assess some nodal, bone, and distant metastases. Multiparametric MRI (mpMRI) has been used for tumor depiction, local-regional staging, follow-up, active surveillance, and therapeutic response assessment (Fig 1). TRUS/MRI fusion guidance improves the accuracy of transrectal biopsies. Prostate-specific membrane antigen (PSMA) PET imaging is well established for evaluating biochemical recurrence. PSMA PET/CT is superior to conventional imaging methods for N and M staging (Fig 2). PET/MRI improves sensitivity in the detection of prostate cancer compared with mpMRI and has also shown interesting applications for cancer depiction, primary staging, assessment of therapeutic responses, and treatment planning. Microultrasound has sensitivity and specificity for clinically significant prostate cancer that are comparable to those of mpMRI. It is a promising low-cost option for prostate cancer depiction and targeted biopsy. Radiomics studies continue to improve prognosis and therapeutic response prediction, paving the way for imaging-based precision medicine.Figure 1. MpMRI evaluation. Axial MR images show a nodular lesion in the peripheral zone that demonstrates typical imaging features that are highly suspicious for a significant cancer, with hypointensity (blue arrow) on the T2-weighted (T2WI) image, restriction to water diffusion (yellow arrows), and marked early contrast enhancement (red arrow) with washout in the late phase (white arrow). ADC = apparent diffusion coefficient, DCE = dynamic contrast-enhanced, T1WI = T1-weighted.Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Upstaged cancer in a patient who had normal results at baseline conventional MRI (not shown) performed for high-risk staging of a recently diagnosed Gleason grade 9 prostate adenocarcinoma (T3N0; prostate-specific antigen level of 7.0 ng/dL). Coronal (A) and axial (B) gallium 68–PSMA PET/CT images show foci of uptake in lymph nodes of the right internal iliac (yellow arrow) and left para-aortic (red arrows) chains. The cancer was upstaged to T3N1M1. Physiologic uptake is seen in the liver, kidneys, bladder, and bowel (white arrows).Figure 2.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest.—S.G. Grant from the University Health Network, Toronto.AcknowledgmentThe authors would like to express their deepest gratitude to Joanne Chin, MFA, ELS, for her editorial support for this article.Supported in part by a Cancer Center Support Grant from the National Cancer Institute (P30 CA008748).Presented as an education exhibit at the 2020 RSNA Annual MeetingS.G. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships.Suggested Readings Ahdoot M, Lebastchi AH, Long L, et al . Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study . Eur Urol Oncol 2021 . https://doi.org/10.1016/j.euo.2021.03.004. Published online April 10, 2021. Google Scholar Ahmed HU, El-Shater Bosaily A, Brown LC, et al . Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study . Lancet 2017 ; 389 ( 10071 ): 815 – 822 . Crossref, Medline, Google Scholar Hofman MS, Lawrentschuk N, Francis RJ, et al . Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study . Lancet 2020 ; 395 ( 10231 ): 1208 – 1216 . Crossref, Medline, Google Scholar Stonier T, Simson N, Shah T, et al . The “Is mpMRI Enough” or IMRIE Study: A Multicentre Evaluation of Prebiopsy Multiparametric Magnetic Resonance Imaging Compared with Biopsy . Eur Urol Focus 2021 ; 7 ( 5 ): 1027 – 1034 . Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 18 2021Revision requested: May 29 2021Revision received: July 11 2021Accepted: July 15 2021Published online: May 27 2022Published in print: July 2022 FiguresReferencesRelatedDetailsAccompanying This ArticleProstate Cancer Imaging: What We Already Know and What Is on the Horizon27 May 2022Default Digital Object SeriesRecommended Articles Current Imaging Techniques for and Imaging Spectrum of Prostate Cancer Recurrence and Metastasis: A Pictorial ReviewRadioGraphics2020Volume: 40Issue: 3pp. 709-726Review of 18F-Fluciclovine PET for Detection of Recurrent Prostate CancerRadioGraphics2019Volume: 39Issue: 3pp. 822-841Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of SpreadRadioGraphics2019Volume: 39Issue: 1pp. 186-212Prostate-specific Membrane Antigen PET: Therapy Response Assessment in Metastatic Prostate CancerRadioGraphics2020Volume: 40Issue: 5pp. 1412-1430Prostate MRI in Stereotactic Body Radiation Treatment Planning and Delivery for Localized Prostate CancerRadioGraphics2022Volume: 42Issue: 4pp. 1251-1264See More RSNA Education Exhibits Prostate Cancer: What We Already Know About What Is on the HorizonDigital Posters2020Current Status and Future Perspective of Molecular Imaging Studies in Prostate CancerDigital Posters2018PET Imaging in Oncology: An Updated Review of Evidence-based IndicationsDigital Posters2020 RSNA Case Collection Locally advanced, metastatic prostate adenocarcinomaRSNA Case Collection2020Hydrogel infiltration into rectal wallRSNA Case Collection2020Radioembolization of Liver Metastasis RSNA Case Collection2020 Vol. 42, No. 4 Slide PresentationAbbreviations Abbreviations: mpMRI multiparametric MRI PSMA prostate-specific membrane antigen Metrics Downloaded 3,230 times Altmetric Score PDF download