Radiation Oncology/Prostate/Workup

Endorectal Magnetic Resonance Imaging On axial T1 gland appears homogeneous and the zonal anatomy is not well appreciated Postbiopsy hemorrhage is evident on T1-weighted images as high T1 signal intensity (important because hemorrhage may mimic tumor on T2 and greatly interferes with assessment of ECE) zonal anatomy is best seen on axial and coronal T2 as are the vas deferens and SV neurovascular bundles best seen on axials penile root is better imaged on T2 coronals peripheral zone is hyperintense whereas tumor appears is HYPOINTENSE (other causes of low T2: hemorrhage, prostatitis, hormone treatment, and RT) Hemorrhage: high T1, low T2 Bone Metastases Detection Brussels, 2007 (Belgium) 17664475 -- "Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: diagnostic and cost-effectiveness and comparison with current detection strategies." (Lecouvet FE, J Clin Oncol. 2007 Aug 1;25(22):3281-7.) Prospective. 66 patients with high-risk PCA (newly diagnosed PCA with GS >=8 and PSA >=20; PSA recurrence after RP with PSADT <12 months; on ADT and PSADT <12 months). Evaluated by bone scan + targetedplain films (BS/TXR) vs. bone scan + targeted plain films + MRI-on request (BS/TXR/MRIor) vs. axial MRI (MRIas) Outcome: 62% bone mets. MRIas more sensitive than current sequence of sequential workup (bone scan, targeted XR, MRI of area at risk) Role of Bone Scan ""Columbia University, 2000"" 11121646 -- "Which patients with newly diagnosed prostate cancer need a radionuclide bone scan? An analysis based on 631 patients" (Lee, N, Int J Radiat Oncol Biol Phys. 2000 vol. 48 (5) pp. 1443-6) Retrospective review of 631 consecutive patients treated at Columbia Presbyterian Medical Center between 1990-1996 who had both a Gleason score and a bone scan. Reviewed clinical factors associated with positive bone scan. Results: 14% with positive bone scan. Multivariate analysis: only Gleason 8-10, PSA>50, and clinical T-category >T2b predicted positive bone scan. All 237 patients with Gleason 2-7, PSA<15 and T-category<T2b had negative scans. 1% of those with Gleason 2-7, PSA<=50, <=T2b had positive bone scan. In those with PSA>50, 49.5% had positive bone scan.