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Extracapsular extension of prostate cancer

Dr Yuranga Weerakkody and Dr Paresh K Desai et al.

Multiple criteria are used to detect extracapsular extension of prostate cancer. They include

an irregular bulge in capsule
obliteration of the rectoprostatic angle
asymmetry of the neurovascular bundle
angulation / step off appearnace of the prostate tumour
focal capsular retraction and or thickening
broad capsular tumour contact (> 12 mm)
breech of the capsule with evidence of direct tumour extension

These criteria can be used both in high resolution transrectal ultrasound / MRI.

MRI is much more superior than transrectal ultrasound, CT and digital rectal examination in detecting extracapsular spread as well as seminal vesicular invasion in prostate cancer.

Criteria for seminal vesicular extension include

direct tumour extension into and around the seminal vesicles
tumour extension along the ejaculatory ducts, resulting in seminal vesicles of low signal intensity in T2WI and non visualisation of the ejaculatory duct.