Prostate Imaging

Small Volume Low Grade Disease

History

  • 60 year-old
  • PSA 3.6
  • 5 of 6 right biopsies GS3+3

Imaging

Small Volume, Low Grade Disease

LEFT: Apparent diffusion coefficient (ADC) map: moderately restricted diffusion

CENTER: T2 Weighted imaging: ill-defined low signal (yellow arrow) does not abut the prostate capsule

RIGHT: Perfusion map: focally increased perfusion

Perfusion time-intensity curve
Whole-mount pathology

LEFT: Perfusion time-intensity curve: type III (washout) curve is highly suspicious

RIGHT: Whole-mount pathology: two low-grade (Gleason Score 3+3=6) tumors do not involve capsule

Advantage: UCLA Prostate MRI

  • Although less sensitive for low-grade disease, MRI can help with determining extent and determination whether surveillance or definitive treatment is warranted.
  • Diffusion weighted imaging (such as Siemens REVEAL) with multiple b-values allows for high contrast-to-background on ADC map and computation of high b-value images