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Prostate Cancer: The Role of Multiparametric Magnetic Resonance Imaging.

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Multiparametric magnetic resonance imaging has been increasingly used for detection, localization and staging of prostate cancer over the last years.

It combines high-resolution T2 weighted-imaging and at least two functional techniques, which include dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and magnetic resonance imaging spectroscopy. Although the combined use of a pelvic phased-array and an endorectal coil is considered the state-of-the-art for magnetic resonance imaging evaluation of prostate cancer, endorectal coil is only absolute mandatory for magnetic resonance imaging spectroscopy at 1.5 T. Sensitivity and specificity levels in cancer detection and localization have been improving with functional technique implementation, compared to T2 weighted-imaging alone.

It has been particularly useful to evaluate patients with abnormal PSA and negative biopsy. Moreover, the information added by the functional techniques may correlate to cancer aggressiveness and therefore be useful to select patients for focal radiotherapy, prostate sparing surgery, focal ablative therapy and active surveillance. However, more studies are needed to compare the functional techniques and understand the advantages and disadvantages of each one.

This article reviews the basic principles of prostatic mp-magnetic resonance imaging, emphasizing its role on detection, staging and active surveillance of prostate cancer.

Abstract available from the publisher.

Acta Med Port. 2015 Mar-Apr;28(2):240-9. Epub 2015 May 29.

Dias JL1, Pina JM2, João R2, Fialho J1, Carmo S1, Leal C1, Bilhim T1, Marques RM1, Pinheiro LC2.

1 Department of Radiology. Hospital de São José. Centro Hospitalar Lisboa Central. Lisboa. Portugal.
2 Department of Urology. Hospital de São José. Centro Hospitalar Lisboa Central. Lisboa. Portugal.

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Ira

This technique is unique because it can detect cancer without sophisticated equipment or contrast. It should be possible for testing at every hospital. I believe that it will become the standard way for image studies.

Best

VG 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

This was the method used at UCSF back in 2012 to screen my prostate for recurring cancer after 3 increases in PSA level following CK treatment 2 years earlier.  Fortunately, the result was negative which calmed my nerves before the PSA levels dropped and have continued to declined consistently ever since.

Every hospital that treats PCa patients should have the equipment necessary to peform an MRSI w/an endorectal coil and any hospital w/MRI capability can easily retrofit their equipment to do so.

Here's a paper on the topic published back in 2006 by Peter Carrol (Professor and Chair of the Urology Dept at UCSF) which I have always found most informative on the topic:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578527/.

 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Many men who are diagnosed  resulting from a biopsy do not in fact obtain an mpMRI since it is not available at many institutions . Instead they do not have the additional diagnostic  test to determine extracapsular extension, etc, and have tests that are not as effective such as a  CT Scan, and many suffer the consequences of treatments that are not necessary or no treatment when treatment is necessary.

As you have noticed I have mentioned the importance of having an mpMRI  numerous times at this site, which, I know,  has become redundant, but I feel necessary.

 

On the techical side the two best magnets are the 1.5T and the superior 3.0T. Since the newer 3.0 is so much more powerful than the 1.5, the test is generally given stand alone, while the 1.5 more often used as MRSI w/an endorectal coil for better results.

Best

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3325
Joined: May 2012

The hospital system I use has just begun using an enhanced MRI device for prostate tumor mapping and tracking, called "Artemis," which is undoubtetdly its market name.  An article in today's paper does not give many engineering detail, but says that it eliminates the need for many biopsies, and allows much more precise guiding of biopsies that are done, essentilly eliminating the current "hit-or-miss" problem with 12-core biopsies.  It is a fusion device, "fusing" MRI and ultrasound results.

The manufacturer is an Eigen Corporation of California.  A chart in the link below says that as of last year, most urologists (51%) were not currently planning to buy the device.  

Some of the enthusiasm is doctors wanting a new toy and the associated bragging rights, part is marketing, and part undoubtedly is that it constitutes a real advance in available technology.

 

http://urologytimes.modernmedicine.com/urology-times/content/tags/art-rastinehad/mri-guiding-future-prostate-cancer-diagnosis?page=full

 

.

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Max, thanks for sharing this well written article about MRI Guided Biopsies.

For the last five and a half years, I have been enrolled in the research program at UCLA with Dr. Marks to measure the effectiveness of this MRI guided biopsy using the Artemis machine. Basically the machine is three dimensional, unlike the two dimensional ultrasound machine that most urologist use, and is able to lock onto the results of an MRI where suspicious lesions may be found and ranked. Because of the precision in targeting the prostate, this machine has the ability to go back to the exact spot at a future biopsy, and target  the surrounding area of that spot where the cancer was found for   further investigation.

As a patient in this program I am more confident in continuing an Active Surveillance protocol that I would be using a two diminsional biopsy as 99 percent of patient now do.

Click my name on the left to see what the results of these biopsies have been.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3325
Joined: May 2012

I'm very glad this device has been available for your use, H&O, and appreciate the firsthand account. The newspaper article mentioned that it is especially useful in active surveillance patients.

hopeful and opt...
Posts: 2226
Joined: Apr 2009

The sequence  of events that I experience is first, have a multiparametric MRI T3; the results are read and any suspicious lesions are ranked from 1 to 5 being most serious by a radiologist; then the urologist is able to lock the results of the MRI using the Artemis machine, and then target the suspicious lesions for core samples ....additionally other cores are taken that are random....usually there are are about 15 or so total cores taken.........I've had four of these biopsies........first, when I entered the program, then one year after.........now it's every two year,  if all goes well............the next one that is scheduled  is Sept 2016

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