Imaging & Biopsy Services
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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.
Imaging Services - Prostate MRI
Indications for Prostate MRI
- Surgical Planning
Benefits from endorectal coil and spectroscopy- Robotic-Assisted Laparoscopic Prostatectomy (RALP)
- Intermediate risk of extracapsular extension
- Biopsy planning (MR or ultrasound fusion)
- Rising PSA/high PSA density & negative biopsy
- Active Surveillance
- Radiotherapy planning
- Follow-up rising PSA ("biochemical failure")
Benefits from endorectal coil and spectroscopy- After prostatectomy or radiotherapy
- Benign disease
Indications for Prostate MRI by Scan Type
- Staging (with endorectal coil, full pelvis, ± spectroscopy)
- Surgical Planning
- Staging (external array, full pelvis, no spectroscopy)
- Radiotherapy planning
- Brachytherapy planning
- Follow-up of rising PSA after prostatectomy or radiotherapy
- Detection (prostate only, external array only)
- Rising PSA (or elevated PSA density) & negative biopsy
- Biopsy planning under MR or US (in development)
- Either Staging or Detection
- Active Surveillance (formerly "watchful waiting")
- Add lumbar spine to pelvis to stage bones/nodes
Prostate MRI: Biopsy Guidance
- In the face of a rising PSA and negative biopsy, a "second look" is warranted
- MRI can pinpoint the most suspicious area in the prostate
- Biopsy can be done directly with MRI or with ultrasound/MRI image fusion under ultrasound guidance
- Technique is optimized for detection, not staging
Radiation (vs. Biopsy) Planning
- Extracapsular extension and seminal vesicle invasion are important, and often the reason surgery is deferred
- Delineation of adjacent structures
- Urethra and bladder
- Rectum
- Pelvic floor muscles and neurovascular bundles
- Evaluates pelvic lymph nodes and bones
- Localization of cancer in the prostate is less important, but can guide a "boost"
- The endorectal coil distorts anatomy, complicating planning, and is omitted
Prostate MRI: Active Surveillance
- In patients with low volume, low grade disease, MRI provides two advantages
- Screen for missed areas suspicious for high-grade cancer
- Baseline imaging for follow-up, to look for subtle changes
Follow-Up Rising PSA: Biochemical Failure
- A rising PSA level after prostatectomy suggests recurrence of cancer
- MRI has been shown to be sensitive to detect recurrent cancer
- Surgical bed
- Bones
- Lymph nodes
- MRI can also detect recurrence in the radiation therapy field