Example of Change to Nerve Sparing

Find your care

Our radiologists lead the way in prostate imaging. We offer the newest techniques to better detect and stage prostate cancer. Call 310-481-7545 to find out more about prostate imaging and treatment options.

History

  • 59 year-old
  • PSA 4.3
  • standard biopsy: 3+3=6 but large volume left

Imaging

Example of Change to Nerve Sparing

LEFT: T2-weighted imaging: hypointense focus left anterior apex (horizontal arrow) with uninvolved neurovascular bundle (vertical arrow)

CENTER: Colorized apparent diffusion coefficient (ADC) map: moderately restricted diffusion (yellow arrow)

RIGHT: Colorized dynamic contrast enhanced (DCE) perfusion map: focal intense enhancement

Spectroscopic imaging for Nerve Sparing
Spectroscopic imaging: elevated choline (left peak) to citrate (right peak) ratios (blue arrows)

Example Report for This Case: Surgical Planning

* Findings

No suspicious lymph nodes or bone lesions. Prostate measures 38 gm with mild prostatic hyperplasia. A single suspicious area is identified:

Location Left anterior central apex 2:00
Capsule Bulges anteriorly only
T2 Asymmetric, ill-defined (4/5)
Diffusion ADC 0.82, highly restricted (4/5)
Perfusion Early and intense + washout (4/5)
Spectroscopy Abnormal
Overall Suspicion High (4/5)

Seminal vesicles and neurovascular bundles appear normal.

* Impression

  1. Technical quality: excellent
  2. Left anterior lesion highly suspicious for aggressive disease may involve anterior capsule
  3. Organ-confined disease.

Result

Final Path: 3+4=7, T2c

Advantage: UCLA Prostate MRI

  • In cases of suspected high volume but organ confined disease, MRI can help with the decision to spare one or both nerves and still achieve negative surgical margins
  • Spectroscopic imaging is the most specific of the functional parameters of prostate MRI, but requires focused experience to accurately tune the magnet