Adenocarcinoma of the Prostate

Abstract

Prostate cancer is the most common cancer and the second most common cause of cancer-related death among men. Because of the advent of prostate-specific antigen (PSA) concentration in serum screening, most prostate cancer new cases are clinically localized at diagnosis, and the 5-year relative survival rate approaches 100 %. Until now, patients with an elevated PSA level or with abnormal findings at digital rectal examination were candidates for further diagnostic evaluation with a transrectal ultrasonography (US)-guided prostate random biopsy for determining the cancer grade; however, random biopsy has some limits, for example, undersampling (35 % cancers missed on first biopsy) or underestimation of the grading. Instead, magnetic resonance (MR) imaging has been shown to be of particular help not only in the detection and localization of prostate cancer but also in staging; accurate assessment is a prerequisite for optimal clinical management and therapy selection. Traditional prostate MR imaging has been based on morphologic imaging with standard T1-weighted and T2-weighted sequences, which has limited accuracy in the detection of prostate cancer: recently, the accuracy is significantly improved by the combined use of standard T2-weighted MR imaging and advanced MR imaging techniques such as diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy. Multiparametric MR imaging provides the highest accuracy in the diagnosis and staging of prostate cancer. In addition, improvements in MR imaging hardware and software (3-T vs 1.5-T imaging) continue to improve spatial and temporal resolution and the signal-to-noise ratio of MR imaging examinations.