Clinical Cases
Case 1 illustrates mpMRI that has been performed following transrectal biopsy in the evaluation for possible management of prostate cancer by active surveillance. Despite significant elevation of PSA to 16 the biopsy had yielded tumour with a low Gleason score of 3+3, present as a single focus of malignant cells within the biopsy cores.
mpMRI demonstrates a 20mm lentiform T2 dark mass that shows restricted diffusion (dark) on the ADC map. Clinically significant malignancy is very likely. The initial biopsy had probably failed to sample this significant lesion that is located within the anterior gland.
Case 2
Case 2 demonstrates mpMRI in the investigation of PSA 3.1 at 6 years following radical prostatectomy (i.e. biochemical failure). A lobulated mass of locally recurrent tumour is detected at the cystourethral anastomosis. A key diagnostic feature is early and rapid enhancement (bright) of the abnormal tissue, as has been demonstrated on the dynamic imaging following gadolinium chelate by intravenous bolus.
Case 3
Case 3 represents mpMRI for the investigation of a progressive rise in PSA from 1.4 to 5.8 in the context of a normal digital rectal examination. A T2 dark mass within the peripheral left lateral part of the gland exhibits both reduced diffusion (dark) on the ADC map and early rapid enhancement (bright). Malignant disease is very likely, and the broad interface with the capsule of the gland indicates a high probability of microscopic extracapsular extension.
REFERENCES
1. Prostate imaging and reporting and data system:
www.acr.org/~/media/ACR/Documents/.../PIRADS/PIRADS%20V2.pdf
2. NZ Ministry of Health proposal for prostate cancer management:
http://www.vision6.com.au/ch/17559/2dfsb12/2322387/1efcax017.docx