UCI Radiology offers state-of-the-art MRI technology for the diagnosis and surveillance of prostate cancer.
In the United States, prostate cancer is the second most common cancer in men and it is estimated that over 190,000 men will receive a diagnosis of prostate cancer, while more than 33,000 men are expected to die from prostate cancer in 2020. The most commonly utilized screening tool is the serum prostate-specific antigen (PSA) along with digital rectal examination. However, PSA can be inaccurate due to confounding issues related to benign prostatic hyperplasia and prostatitis. The ability to accurately identify clinically significant prostate cancer is crucial to adequate management of prostate cancer.
Magnetic resonance imaging (MRI) of the prostate is a reliable tool for detection and staging of prostate cancer. Multiparametric prostate MRI allows us to accurately visualize suspicious prostate lesions and facilitate targeting of those lesions for biopsy, thus improving the accuracy of prostate cancer diagnosis. Additionally MRI allows for localization of tumor prior to localized therapies.
During the past 10 years, there have been significant technical advances in prostate MRI and marked standardization of prostate MRI interpretation and reporting. The current state of the art deployed at UCI includes advanced imaging techniques on 3 Tesla MRI’s, which have undergone extensive quality control. Our protocols do not require endorectal coils, which have shown low patient satisfaction. We also utilize the latest in prostate reporting standards, PI-RADS version 2.1.
Prostate MRI — Small field of view high resolution Axial T2 image of the prostate with segmentation of the prostate and a right posterior peripheral PI-RADS 4 lesion, resulting in a Gleason 4+3 targeted biopsy result
Anterior lesion T2 and ADC map — On the right- small field of view high resolution Axial T2 image, and on the left- apparent diffusion coefficient map, with segmentation of the prostate and a large anterior PI-RADS 5 lesion in patient with previous negative biopsy, resulting in Gleason 4+4 targeted biopsy result.
Common indications for prostate MRI include, elevated serum PSA, elevated PSA with prior negative transrectal prostate biopsy, abnormal digital rectal exam, and suspicious genomic profile. Prostate MRI in biopsy naïve patients has been associated with improved care resulting in decreased overdiagnosis of indolent disease while improving the detection of clinically significant prostate cancer.
At UCI, our board certified abdominal radiologists combined have over 20 years of experience with prostate MRI. We have partnered with urology and pathology for radiologic and pathologic lesion analysis. Our radiologists also regularly attend genitourinary tumor board and play a vital role in patient care. Additionally, our faculty have initiated and been involved with multiple prostate MRI research projects, yielding presentations at nationaland international scientific meetings as well as multiple publications. We are at the forefront of prostate MRI research applying advanced artificial intelligence techniques to improve detection and classification of prostate cancer.
At UCI, prostate MRI is routinely utilized for the care of prostate cancer patients. We utilize combined systemic and MRI targeted biopsies with a high degree of success in identifying clinically significant prostate cancer. Prostate MRI is an important component of patient selection for active surveillance of patients with low risk prostate cancer. Our high resolution prostate MRI’s are also able to accurately assess local staging of prostate cancer and verify the organ confined status of the cancer. MRI assessment of pelvic lymph nodes is utilized for tumor localization in radiation therapy planning.
Roozbeh Houshyar, MD