Prostate cancer - multiparametric imaging on 3T MRI

Case contributed by Dr Chris O'Donnell

Presentation

Persistent elevation of PSA (12 ng/ml). Initial routine TRUS biopsy was negative. Follow-up saturation TRUS biopsy (24 cores) was also negative. MRI for "clearance" of malignancy

Patient Data

Age: 55
Gender: Male

Typical features of prostate cancer on MRI = T2 hypointense lesion with restricted diffusion, low ADC and increased K trans ie microvascular permeability

Case Discussion

This cancer is in a location that is notoriously difficult to diagnose on transrectal biopsy ie at the apex of the gland anteriorly immediately adjacent to the urethra.  Most TRUS biopsies target the peripheral zone (site of most cancers) and the central zone in the midportion of the gland.   This patient had a positive histological diagnosis following a 3rd "grided" or "templated" transperineal ultrasound-guided biopsy targetting the periurethral tissue of the gland (with a urethral catheter in situ).  This is the same technique used by radiation oncologists for brachytherapy of prostate cancer.
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Case Information

rID: 19238
Case created: 19th Aug 2012
Last edited: 25th Sep 2015
System: Urogenital
Inclusion in quiz mode: Included

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