MR-Guided Interventions for Prostate Cancer
Section snippets
MR imaging for prostate cancer
It is unfortunate that there is no single imaging method that embodies all of the optimal characteristics for the integration of diagnostic and interventional procedures for prostate cancer. CT permits accurate spatial visualization of interventional devices (Fig. 1A) but does not provide real-time feedback or adequate soft tissue delineation. Transrectal ultrasound (TRUS) is the current “gold standard” for guiding prostate interventions due to its ease of use and real-time image feedback. Soft
Needle core biopsy
Currently, prostate biopsy is conducted under TRUS guidance. Although a positive biopsy result is a clear indication of cancer, a negative biopsy result is often indefinite and problematic because it is known that the sextant biopsy procedure has a relatively low sensitivity and high sampling error [25]. To address this problem, an 8- to 10-biopsy regimen, depending on prostate size, has been proposed [26], with sensitivity increasing up to 80%. Repeat sextant biopsy is another approach, which
Permanent implant
For patients with localized prostate cancer at low risk for extraprostatic extension, permanent-seed brachytherapy is an accepted and effective minimally invasive treatment strategy. Radioactive seeds are conventionally placed and left throughout the prostate gland under ultrasound guidance using a transperineal template. One important performance measure of the procedure is the proportion of the prostate gland receiving the minimum desired dose. Treatment-related toxicity is associated with
Thermal therapy
The role of thermal therapies for patients with prostate cancer remains investigational at this time. Beyond anatomic guidance, there is a strong rationale for integrating thermal treatment, specifically heat therapy, in the MR imaging environment where temperature can be monitored noninvasively during the procedure [59]. This treatment has been demonstrated by Chen and colleagues [60], whereby patients who had locally recurrent prostate carcinoma received percutaneous interstitial microwave
Summary
MR imaging is currently the most effective diagnostic imaging tool for visualizing the anatomy and pathology of the prostate gland. Currently, the practicality and cost effectiveness of transrectal ultrasound dominates image guidance for needle-based prostate interventions. Challenges to the integration of diagnostic and interventional MR imaging have included the lack of real-time feedback, the complexity of the imaging technique, and limited access to the perineum within the geometric
References (63)
Gleason grading and prognostic factors in carcinoma of the prostate
Mod Pathol
(2004)- et al.
The contribution of magnetic resonance imaging to the three-dimensional treatment planning of localized prostate cancer
Int J Radiat Oncol Biol Phys
(1999) - et al.
Inverse treatment planning based on MRI for HDR prostate brachytherapy
Int J Radiat Oncol Biol Phys
(2005) - et al.
Clinical utility of endorectal MRI in determining PSA outcome for patients with biopsy Gleason score 7, PSA < or = 10, and clinically localized prostate cancer
Int J Radiat Oncol Biol Phys
(2003) - et al.
Combined modality staging of prostate carcinoma and its utility in predicting pathologic stage and postoperative prostate specific antigen failure
Urology
(1997) - et al.
Endorectal coil magnetic resonance imaging identifies locally advanced prostate cancer in select patients with clinically localized disease
Urology
(1998) - et al.
Combination of the preoperative PSA level, biopsy Gleason score, percentage of positive biopsies, and MRI T-stage to predict early PSA failure in men with clinically localized prostate cancer
Urology
(2000) - et al.
Quantifying the impact of seminal vesicle invasion identified using endorectal magnetic resonance imaging on PSA outcome after radiation therapy for patients with clinically localized prostate cancer
Int J Radiat Oncol Biol Phys
(2004) - et al.
Preoperative neural network using combined magnetic resonance imaging variables, prostate specific antigen and Gleason score to predict prostate cancer stage
J Urol
(2004) - et al.
The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer
Urology
(1997)
The appearance of prostate cancer on transrectal ultrasonography: correlation of imaging and pathological examinations
J Urol
Incidence and clinical significance of false-negative sextant prostate biopsies
J Urol
Heterogeneity of prostate cancer in radical prostatectomy specimens
Urology
Transperineal magnetic resonance image guided prostate biopsy
J Urol
Real time MRI-ultrasound image guided stereotactic prostate biopsy
Magn Reson Imaging
Measurement of intrafractional prostate motion using magnetic resonance imaging
Int J Radiat Oncol Biol Phys
Three-dimensional intrafractional movement of prostate measured during real-time tumor-tracking radiotherapy in supine and prone treatment positions
Int J Radiat Oncol Biol Phys
A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer
Radiother Oncol
Real-time magnetic resonance image-guided interstitial brachytherapy in the treatment of select patients with clinically localized prostate cancer
Int J Radiat Oncol Biol Phys
Comparing PSA outcome after radical prostatectomy or magnetic resonance imaging-guided partial prostatic irradiation in select patients with clinically localized adenocarcinoma of the prostate
Urology
Towards integrating functional imaging in the treatment of prostate cancer with radiation: the registration of the MR spectroscopy imaging to ultrasound/CT images and its implementation in treatment planning
Int J Radiat Oncol Biol Phys
The role of endorectal coil MRI in patient selection and treatment planning for prostate seed implants
Int J Radiat Oncol Biol Phys
Deformable image registration for the use of magnetic resonance spectroscopy in prostate treatment planning
Int J Radiat Oncol Biol Phys
Magnetic resonance spectroscopic imaging-guided brachytherapy for localized prostate cancer
Int J Radiat Oncol Biol Phys
MRI-guided prostate brachytherapy with single needle method—a planning study
Radiother Oncol
A randomized trial comparing a conbination of iridium implant and external beam radiation to external beam radiation alone for patients with locally advanced prostate cancer
Inverse planning for HDR prostate brachytherapy used to boost dominant intraprostatic lesions defined by magnetic resonance spectroscopy imaging
Int J Radiat Oncol Biol Phys
MRI-guided HDR prostate brachytherapy in standard 1.5T scanner
Int J Radiat Oncol Biol Phys
Cancer statistics, 2004
CA Cancer J Clin
Prostate specific antigen: an updated review
Can J Urol
Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectomies
Am J Surg Pathol
Cited by (33)
Impact of a 1.5 T magnetic field on DNA damage in MRI-guided HDR brachytherapy
2020, Physica MedicaDevelopment and Testing of a Magnetic Resonance (MR) Conditional Afterloader for Source Tracking in Magnetic Resonance Imaging-Guided High-Dose-Rate (HDR) Brachytherapy
2018, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :This development of MR-guided HDR brachytherapy using an MR conditional afterloader enables large improvements of the clinical workflow. In current MR-guided HDR brachytherapy workflows, MRI has been incorporated into the processes of diagnosis, treatment planning, and/or pre- and post-irradiation imaging (1, 2, 20-22, 29, 30). However, these workflows necessarily require displacements of the patient between imaging/treatment planning and radiation delivery.
ProstAtlas: A digital morphologic atlas of the prostate
2012, European Journal of RadiologyCitation Excerpt :In this study we were interested by the creation of a morphologic atlas of the prostate. Indeed, in the last years many computerized and roboterized procedures were developed for prostate cancer management [17–19]. Therefore, it becomes important to have a global framework for validation and comparison of these procedures.
Transanorectal Interventions
2008, Seminars in Ultrasound, CT and MRICitation Excerpt :Magnetic resonance (MR) guidance is receiving increased attention as a tool for interventions, including transanal and transrectal interventions. Techniques for MR-guided biopsy, brachytherapy, and external radiation of the prostate have been developed and are in current clinical use.6-8 MRI is currently the most effective diagnostic imaging tool for visualizing the anatomy and pathology of the prostate gland, including prostate cancer.
Quality Assurance Issues for Computed Tomography-, Ultrasound-, and Magnetic Resonance Imaging-Guided Brachytherapy
2008, International Journal of Radiation Oncology Biology PhysicsTreatment of Prostate Cancer Local Recurrence After Radical Retropubic Prostatectomy with 17-Gauge Interstitial Transperineal Cryoablation: Initial Experience
2007, UrologyCitation Excerpt :In our cohort, all local recurrences were identified by endorectal coil gadolinium-enhanced dynamic MRI, with subsequent ultrasound-guided transrectal biopsy of these lesions and treatment under real-time ultrasound guidance. MRI, with superior contrast resolution, as well as multiplanar and three-dimensional imaging capability, is the most effective form of imaging available to assess the prostate anatomy and pathologic features.16 Real-time MRI with ultrasonography has been used to direct prostate biopsies17,18 and MRI-guided percutaneous cryoablation of hepatic tumors.19
This work was supported in part by the National Science Foundation grant NSF ERC9731478, the US Army grant PC10029, and the National Institutes of Health grants R01 HL 57483 and R01 HL 61672.