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Radiation Oncology/Prostate/Workup

< Radiation Oncology | Prostate
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Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

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Prostate: Main Page | Prostate Overview | Screening and Prevention | Workup | Natural History | External Beam RT | IMRT | Androgen Suppression Therapy | Brachytherapy | Protons | Prostatectomy | Adjuvant RT after Prostatectomy | Salvage RT | Chemotherapy | Localized prostate cancer | Node Positive | Advanced disease | Recurrence after RT | Cryotherapy | RTOG Prostate Trials | Randomized Evidence

Endorectal Magnetic Resonance Imaging

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  • On axial T1 gland appears homogeneous and the zonal anatomy is not well appreciated
  • Postbiopsy hemorrhage is evident on T1-weighted images as high T1 signal intensity (important because hemorrhage may mimic tumor on T2 and greatly interferes with assessment of ECE)
  • zonal anatomy is best seen on axial and coronal T2 as are the vas deferens and SV
  • neurovascular bundles best seen on axials
  • penile root is better imaged on T2 coronals
  • peripheral zone is hyperintense whereas tumor appears is HYPOINTENSE (other causes of low T2: hemorrhage, prostatitis, hormone treatment, and RT)
  • Hemorrhage: high T1, low T2


Bone Metastases Detection

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  • Brussels, 2007 (Belgium) PMID 17664475 -- "Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: diagnostic and cost-effectiveness and comparison with current detection strategies." (Lecouvet FE, J Clin Oncol. 2007 Aug 1;25(22):3281-7.)
    • Prospective. 66 patients with high-risk PCA (newly diagnosed PCA with GS >=8 and PSA >=20; PSA recurrence after RP with PSADT <12 months; on ADT and PSADT <12 months). Evaluated by bone scan + targetedplain films (BS/TXR) vs. bone scan + targeted plain films + MRI-on request (BS/TXR/MRIor) vs. axial MRI (MRIas)
    • Outcome: 62% bone mets. MRIas more sensitive than current sequence of sequential workup (bone scan, targeted XR, MRI of area at risk)

Role of Bone Scan

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  • ""Columbia University, 2000"" PMID 11121646 -- "Which patients with newly diagnosed prostate cancer need a radionuclide bone scan? An analysis based on 631 patients" (Lee, N, Int J Radiat Oncol Biol Phys. 2000 vol. 48 (5) pp. 1443-6)
    • Retrospective review of 631 consecutive patients treated at Columbia Presbyterian Medical Center between 1990-1996 who had both a Gleason score and a bone scan. Reviewed clinical factors associated with positive bone scan.
    • Results: 14% with positive bone scan. Multivariate analysis: only Gleason 8-10, PSA>50, and clinical T-category >T2b predicted positive bone scan. All 237 patients with Gleason 2-7, PSA<15 and T-category<T2b had negative scans. 1% of those with Gleason 2-7, PSA<=50, <=T2b had positive bone scan. In those with PSA>50, 49.5% had positive bone scan.
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