Imaging

Prostate Cancer

Preliminary Diagnosis: Prostate Cancer

I. What imaging technique is first-line for this diagnosis?

Prostatic ultrasound.

II. Describe the advantages and disadvantages of this technique for diagnosing prostate cancer.

Advantages

  • Moderately sensitive and specific in detecting, detailing, and characterizing prostate abnormalities, such as cancer.

  • May help guide biopsy.

  • Highly specific in characterizing the vascularity of a neoplastic process.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Less adept in detailing the extent of soft tissue infiltration and extension.

  • Highly operator dependent.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • MRI with IV contrast.

  • CT imaging with IV contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing prostate cancer.

MRI with IV contrast

Advantages

  • Gold standard in detecting, detailing, and characterizing prostate neoplasm and extension of neoplasm.

  • Does not expose patients to ionizing radiation.

  • Offers exquisite detail of the surrounding soft tissues and the zones of the prostate gland (central, peripheral, and transitional zone).

  • Contrasted MR imaging helps evaluate for any secondary complications.

Disadvantages

  • May be subject to motion and susceptibility weighted artifact, degrading image quality.

  • Less sensitive and specific for detailing the osseous structures.

  • Expensive.

  • Time consuming.

CT imaging with IV contrast

Advantages

  • Quick and relatively inexpensive imaging modality as compared to MR imaging.

  • May help guide percutaneous biopsy and treatment.

  • Moderately sensitive and specific in characterizing the surrounding soft tissues and extension of tumors.

  • Highly sensitive and specific in characterizing the surrounding osseous and mineralized structures.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Contrasted CT imaging helps evaluate for any secondary complications.

VI. What are the contraindications for the alternative imaging techniques?

MRI with IV contrast

May be contraindicated in patients with non-MR compatible hardware.

CT imaging with IV contrast

May be contraindicated in patients who are pregnant.

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