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1、ProstateCancer:RadiologicalDiagnosis,Staging,andDetectionofMetastasisLauraRosow,HMSIIIGillianLieberman,MDBIDMCCoreClerkshipinRadiologyFebruary23,2009PACS,BIDMCOutlineI.IndexpatientII.OverviewofprostatecancerIII.ProstateanatomyIV.Roleofimaginginthediagnosis/stag
2、ingofprostatecancerV.DetectingosseousmetastasesPartI:IndexPatientPatient“TM”:Presentationandhistory•TM–a69year-oldmale•OnroutinelabworkathisPCP’soffice:•Prostatespecificantigen(PSA):5.5ng/mL•Increasedfrom5yearsprior,whenhisPSAwas3.0ng/mL•CalculatedPSAvelocity:0
3、.5ng/mLperyear•PMH/PSH:•s/pRepairoftibialplateaufracture•s/pTURPforalleviationofprostatitis–nocancerfoundatthattime.OnthebasisofTM’smoderatelyelevatedPSAandPSAvelocity,adecisionwasmadetoperformatransrectalultrasound(TRUS)-guidedprostatebiopsy.PatientTM:TRUS-gui
4、dedprostatebiopsyPROSTATEGLANDPACS,BIDMC10corebiopsiesweretakenfromthroughouttheprostategland.PatientTM:Biopsyfindings•Leftmid-glandadenocarcinoma,Gleasonscore6/10,involving5-10%ofcorebiopsy•Rightbaseadenocarcinoma,Gleasonscore6/10,involving30%ofcorebiopsy•High
5、-gradeprostaticintraepithelialneoplasia(PIN)throughoutleftbase.InordertofurthercharacterizethesizeandextentofTM’sprostatecancer,anendorectalMRIwasperformed.PatientTM:EndorectalMRIPROSTATEGLANDRECTUM(dilatedwithballoon)T2AxialContrast-EnhancedMRIPACS,BIDMCPatien
6、tTM:MRIfinding#1Focusofprostatecancerinrightperipheralzone.Noextracapsularextension.HEMORRHAGE(normalpost-biopsyCANCERchange)T2AxialContrast-EnhancedMRIPACS,BIDMCPatientTM:MRIfinding#2Leftlobemid-glandperipheralzoneprostatecancer,11mm.Noextracapsularextension.C
7、ANCERT2AxialContrast-EnhancedMRIPACS,BIDMCPatientTM:Stagingandtreatment•GiventhatTM’scancerwasbilateral,yetconfinedtotheprostategland,hiscancerwasSTAGEII.•Someofhistreatmentoptionsincluded*:•Expectantmanagement(aka“watchfulwaiting”)•Radicalprostatectomy•Brachyt
8、herapy+/-adjuvanthormonaltherapy•TMoptedfor4monthsofhormonaltherapy,followedbybrachytherapy.•5monthsfollowingbrachytherapy,arepeatPSAwas0.1ng/mL.*SchroderFHetal(2008).Clinic
