Role of MRI and MRSI in The Role of MRI and MRSI in The Management of Prostate CancerManagement of Prostate Cancer

Karim Touijer, MDKarim Touijer, MD

Case Scenario

• Healthy 59 y/o male • PSA: 3.4 ng/ml• DRE: cT2a Left Mid and Apex induration

• Biopsy: Gleason 7 (4+3) Left Mid and Apex 2/6 cores positive, 70% involvement

• Nomogram Predictions:OC 47%, ECE 45%, SVI 6%, LNI 2%

Transurethral Resection of the Bladder

Role of the MRI

• Disease Staging

• Treatment planning

• Repeat Biopsy

• Diagnosis of local recurrence after surgery

•Retrospective review 612 MRI/MRSI

•Clinical information was available to the radiologist at the time of MRI

•Predictions of staging given by the radiologist

•Compared to the Partin tables predicted probability

This study needs to be reproduced by others

• 135 patients – 270 NVB

• Pre MRIPre MRITreatment plan: 1 preserve -------5 resect

• Post MRIPost MRITreatment plan: - Unchanged - More conservative - More aggressive

• Pathology results as a standard referencePathology results as a standard reference

13%

31% 31%

37% 42%

Overall The MRI did Improve the Surgeons’ Overall The MRI did Improve the Surgeons’ Decision to Preserve or Resect the NVBDecision to Preserve or Resect the NVB

61 y/o, cT2a, Gl 7, PSA: 5.4 Pre MRI: Probable Preservation

60 y/o cT1c, Gl 9, PSA: 8.45 Pre MRI: Probable Preservation

Anterior Tumors• Preoperative features of anterior

prostate tumors can underestimate the volume and extent of disease

• Lower clinical stage

• More negative prostate biopsies in the past

• Lower number and proportion of positive biopsy cores

• More favorable PFP prediction using contemporary prediction instruments.

Trends in Anterior tumors at MSKCC Trends in Anterior tumors at MSKCC from 2000 to 2003from 2000 to 2003

Trends in Anterior tumors at MSKCC Trends in Anterior tumors at MSKCC from 2000 to 2003from 2000 to 2003

http://radiology.rsnajnls.org/content/vol239/issue3/images/large/r06ma01g04a.jpeg

Conclusion

• 344 patients with prostate cancer

• Prediction of ECE by nomogram vs.MRI read by GU radiologists

• Prediction of ECE by nomogram vs. MRI read by general radiologists

Genitourinary RadiologistsGenitourinary Radiologists General radiologistGeneral radiologist

Conclusions

• MRI is a helpful tool in staging and treatment planning.

• MRI adds extra-information to the already existing tools

• MRI interpretation is highly dependent on the experience of the reader

• Accurate imaging of prostate cancer is an important step towards focal therapy for prostate cancer