Review ArticlesThe Evolving Role of Imaging in Identification and Management of Prostate CancerIntroductionDavid G McLeod
Review ArticlesMagnetic Resonance Imaging and Spectroscopy of Prostate CancerProstate Cancer ImagingPeter R CarrollFergus V CoakelyJohn KurhanewiczMagnetic resonance imaging may improve the staging of prostate cancer compared with clinical evaluation alone, computerized tomography, or transrectal ultrasound, and it allows simultaneous and detailed evaluation of prostatic, periprostatic, and pelvic anatomy. Endorectal magnetic resonance imaging and magnetic resonance spectroscopic imaging (endoMRI/MRSI) allow better visualization of the zonal anatomy of the prostate and better delineation of tumor location, volume, and extent (stage). Metabolic criteria used to identify and localize prostate cancer with endoMRI/MRSI have been standardized, thus improving the accuracy of the examination and limiting interobserver variations in interpretation. Evidence is now emerging that endoMRI/MRSI may also be helpful in assessing response to prostate cancer treatment, most commonly with radiation and/or androgen-deprivation therapy. [Rev Urol. 2006;8(suppl 1):S4-S10]Prostate cancerMagnetic resonance imagingMagnetic resonance spectroscopyEndorectal MRI
Review ArticlesFused Radioimmunoscintigraphy for Treatment PlanningProstate Cancer ImagingRodney J EllisDeborah A KaminskyAdvances in imaging technologies, including computerized tomography (CT) and single-photon emission tomography (SPECT), are improving the role of imaging in prostate cancer diagnosis and treatment. Hybrid (SPECT/CT) imaging, in particular, shows an increased sensitivity for identification of prostate cancer. Published studies have also recently proposed a new paradigm in the administration of radiation therapy for prostate cancer, favoring doseescalation strategies to improve tumor control for localized disease. Conventional dose-escalation protocols have previously relied primarily on margin extension to the entire prostate gland to achieve dose-escalation; extending increased risk to radiosensitive normal structures. A newer strategy proposes use of advanced imaging to confine dose-escalation to biological target volumes identified on capromab pendetide SPECT/CT-fused image sets or imageguided radiation therapy (IGRT). This strategy defines a shift in radiation dosimetry and planning from uniform glandular prescription dosing with doseescalation applied generically to the peripheral regions and margin extension; to dose-escalation confinement to discrete regions of known disease as defined by focal uptake on radioimmunoscintigraphy fusion with anatomic image sets, with minimal margin extension. The introduction of advanced imaging for IGRT in prostate cancer has also introduced an improved capability for the early-identification of patients at risk for metastatic disease, where more aggressive therapeutic interventions may prove beneficial. [Rev Urol. 2006;8(suppl 1):S11-S19]Prostate cancerRadiotherapyBrachytherapyProstaScintSPECT/CTBiological targetvolumesSurvival
Review ArticlesThe Emergence of Radioimmunoscintigraphy for Prostate CancerProstate Cancer ImagingDavid G McLeodThomas E KeaneInger L RosnerM Scott WingoThe ability to label tissue-specific antibodies has long been of interest for improving detection and guidance for therapeutic applications. The most studied target for prostate cancer is the prostate-specific membrane antigen, which is upregulated in prostate cancer, hormone-refractive disease, and prostate cancer metastases. Investigations using radioimmunoscintigraphy with the radiolabeled 7E11 antibody capromab pendetide have significantly improved sensitivity for prostate cancer detection compared with standard cross-sectional imaging, based on tissue confirmation of pathologic results. Over the past 5 years, significantly greater image resolution from improved camera technology and the use of co-registration to fuse functional and anatomic (computerized tomography and magnetic resonance imaging) images have dramatically enhanced prostate cancer localization. Outcomes data from several sources have spurred a resurgence in interest in this imaging modality. [Rev Urol. 2006;8(suppl 1):S20-S28]Prostate cancerProstaScintProstate-specific membrane antigenRadioimmunoscintigraphyCapromab pendetideImage co-registrationLymph node metastasis
Review ArticlesContrast-Enhanced Ultrasound Imaging of Prostate CancerProstate Cancer ImagingEthan J HalpernUltrasound imaging of the prostate is commonly used to assess the size of the gland and for needle placement during systematic biopsy. Ultrasound evaluation of prostate cancer is limited by difficulty in distinguishing benign from malignant tissue. Although Doppler techniques may provide some improvement in the detection of prostate cancer, targeted biopsy based on conventional ultrasound with Doppler is not sufficient to replace systematic biopsy. Contrast-enhanced ultrasound imaging techniques that employ microbubble contrast agents represent an innovative approach to imaging of the neovascularity associated with prostate cancer. This review describes the application of contrast-enhanced ultrasound to improve detection and assessment of prostate cancer. [Rev Urol. 2006;8(suppl 1):S29-S37]Prostate cancerDopplerUltrasoundMicrobubble contrast agents