Prostate MR

General

  • African American most common population

  • Most common primary malignancy in men, second most common cause of death

  • IV glucagon commonly given to slow bowel peristalsis so there is less motion artifact

  • Contrast typically not needed

  • The MRI is typically for staging although increasingly used to screen

  • PSA

    • Normal = 1-4

    • >4 is abnormal

Prostate Cancer

  • 95% = adenocarcinoma

  • 70% = Peripheral zone

    • Majority will be area of hypointensity

    • Mucinous adenocarcinoma (5%) will be area of increased signal in peripheral zone

  • 30% = Central and anterior zone

  • Note if there was a recent biopsy then will have area of high T1 signal because of blood

Neurovascular bundle

  • The straight lines that look like they are extending laterally from the posterior border of the prostate

  • If they look hazy then consider involvement, doesn’t look like definitive invasion can just have haziness around it

  • Black arrows in image below

T Stage

  • T1: Clinically localized [tumor not palpable on digital rectal exam (DRE)]

  • T2: Tumor confined to prostate

  • T3: Locally invasive beyond prostatic capsule

  • T4: Tumor is fixed or invades adjacent structures other than seminal vesicles, such as external sphincter, rectum, bladder, levator muscles, &/or pelvic wall

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