Dynamic Contrast-Enhanced MRI for Preoperative Identification of Localised Prostate Cancer

ObjectivesTo assess the value of pelvic-phased array (PPA) dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting intraprostatic tumour location and volume for clinically localised prostate cancers.MethodsSuspicious areas on prospective prebiopsy MRI were located with respect to anatomic features, gland side, and transition zone (TZ) and peripheral zone (PZ) boundaries. These MRI findings were compared with histopathology findings for the radical prostatectomy specimens. Literature review of original studies correlating MRI and histologic results was performed.ResultsDCE-MRI with a PPA is superior to T2-weighted sequences for the detection and depiction of intraprostatic prostate cancer. In a series of 24 cases with 56 separate cancer foci, sensitivity, specificity, and positive and negative predictive values for cancer detection by MRI were, respectively, 77%, 91%, 86%, and 85% for foci >0.2 cc, and 90%, 88%, 77%, and 95% for foci >0.5 cc. Median focus volume was 1.37 cc (range: 0.338–6.32) for foci >0.2 cc detected by MRI in PZ, and 0.503 cc (range: 0.337–1.345) for those not detected by MRI (p < 0.05). The corresponding values for TZ foci were 2.54 (range: 0.75–16.87) and 0.435 (range: 0.26–0.58).ConclusionsPrebiopsy PPA DCE-MRI is an accurate technique for detecting and quantifying intracapsular TZ or PZ tumour foci >0.2 cc. It has several applications, such as screening for prostate cancer and excluding cancer in patients with a raised PSA level, targeting of biopsies, estimating cancer volume and prognosis, and, in the future, monitoring of disease both during active surveillance and after focal therapy.