Abstract
Prostate cancer is unique in that unlike other solid organ malignancies, only recently has imaging been employed to routinely detect and localize disease. The introduction of transrectal ultrasound was a significant development, transitioning digitally guided prostate biopsies to ultrasound guidance. The arrival of multiparametric MRI has become the next major step, transforming the way Urologist’s diagnose, stage, and treat prostate cancer. Recent recommendations against PSA screening have changed the landscape of urologic oncology with the changing needs being reflected in the initiation of additional robust imaging techniques at different time points in prostate cancer care. The current review aims to provide a clinical perspective in the history, current standard of care, and novel imaging modalities in the evaluation of prostate cancer.
Similar content being viewed by others
References
Dellavedova T (2016) Prostatic specific antigen. From its early days until becoming a prostate cancer biomarker. Arch Esp Urol 69(1):19–23
Taneja SS (2004) Imaging in the diagnosis and management of prostate cancer. Rev Urol 6(3):101–113
Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30
Eggener SE, et al. (2015) Gleason 6 prostate cancer: translating biology into population health. J Urol 194(3):626–634
George AK, Pinto PA (2015) Editorial comment. Urology 85(2):429
Fascelli M, et al. (2015) The role of MRI in active surveillance for prostate cancer. Curr Urol Rep 16(6):42
Lee F, et al. (1985) Transrectal ultrasound in the diagnosis of prostate cancer: location, echogenicity, histopathology, and staging. Prostate 7(2):117–129
Ragde H, Aldape HC, Bagley CM Jr (1988) Ultrasound-guided prostate biopsy. Biopty gun superior to aspiration. Urology 32(6):503–506
Frye TP, Pinto PA, George AK (2015) Optimizing patient population for MP-MRI and fusion biopsy for prostate cancer detection. Curr Urol Rep 16(7):50
Rothwax JT, et al. (2014) Multiparametric MRI in biopsy guidance for prostate cancer: fusion-guided. Biomed Res Int 2014:439171
Watanabe H, et al. (1974) Development and application of new equipment for transrectal ultrasonography. J Clin Ultrasound 2(2):91–98
Resnick MI, Willard JW, Boyce WH (1980) Transrectal ultrasonography in the evaluation of patients with prostatic carcinoma. J Urol 124(4):482–484
Rifkin MD, et al. (1983) Endoscopic ultrasonic evaluation of the prostate using a transrectal probe: prospective evaluation and acoustic characterization. Radiology 149(1):265–271
Griffiths GJ, et al. (1987) The ultrasound appearances of prostatic cancer with histological correlation. Clin Radiol 38(3):219–227
Egawa S, et al. (1992) Unusual hyperechoic appearance of prostate cancer on transrectal ultrasonography. Br J Urol 69(2):169–174
Lee F, et al. (1989) Hypoechoic lesions of the prostate: clinical relevance of tumor size, digital rectal examination, and prostate-specific antigen. Radiology 170(1 Pt 1):29–32
Hodge KK, et al. (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142(1):71–74 (discussion 74–5)
Barrett T, et al. (2012) Value of the hemorrhage exclusion sign on T1-weighted prostate MR images for the detection of prostate cancer. Radiology 263(3):751–757
Barentsz JO, et al. (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22(4):746–757
Kirkham AP, Emberton M, Allen C (2006) How good is MRI at detecting and characterising cancer within the prostate. Eur Urol 50(6):1163–1174 (discussion 1175)
McNeal JE, et al. (1988) Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 12(12):897–906
Sakai I, et al. (2006) Analysis of differences in clinicopathological features between prostate cancers located in the transition and peripheral zones. Int J Urol 13(4):368–372
Iremashvili V, et al. (2012) Prostate cancers of different zonal origin: clinicopathological characteristics and biochemical outcome after radical prostatectomy. Urology 80(5):1063–1069
Beyersdorff D, et al. (2002) Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: value of MR imaging. Radiology 224(3):701–706
Presti JC Jr, et al. (1996) Local staging of prostatic carcinoma: comparison of transrectal sonography and endorectal MR imaging. AJR Am J Roentgenol 166(1):103–108
Stattin P, et al. (2015) Improving the specificity of screening for lethal prostate cancer using prostate-specific antigen and a panel of kallikrein markers: a nested case-control study. Eur Urol 68(2):207–213
Tinzl M, et al. (2004) DD3PCA3 RNA analysis in urine–a new perspective for detecting prostate cancer. Eur Urol 46(2):182–186 (discussion 187)
Catalona WJ, et al. (2011) A multicenter study of [-2]pro-prostate specific antigen combined with prostate specific antigen and free prostate specific antigen for prostate cancer detection in the 2.0 to 10.0 ng/ml prostate specific antigen range. J Urol 185(5):1650–1655
Loeb S, Catalona WJ (2014) The prostate health index: a new test for the detection of prostate cancer. Ther Adv Urol 6(2):74–77
McDonald ML, Parsons JK (2016) 4-kallikrein test and kallikrein markers in prostate cancer screening. Urol Clin North Am 43(1):39–46
Mohler JL, et al. (2016) Prostate Cancer, version 1.2016. J Natl Compr Cancer Netw 14(1):19–30
Serefoglu EC, et al. (2013) How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer? Can Urol Assoc J 7(5–6):E293–E298
Volkin D, et al. (2014) Multiparametric magnetic resonance imaging (MRI) and subsequent MRI/ultrasonography fusion-guided biopsy increase the detection of anteriorly located prostate cancers. BJU Int 114(6b):E43–E49
Nevoux P, et al. (2012) Quantitative tissue analyses of prostate cancer foci in an unselected cystoprostatectomy series. BJU Int 110(4):517–523
Tawadros T, Valerio M (2016) Addressing overtreatment following the diagnosis of localized prostate cancer. Expert Rev Anticancer Ther 16:373–374
Rastinehad AR, et al. (2014) Improving detection of clinically significant prostate cancer: magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy. J Urol 191(6):1749–1754
Siddiqui MM, et al. (2015) Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. Jama 313(4):390–397
Turkbey B, et al. (2014) Comparison of endorectal coil and nonendorectal coil T2W and diffusion-weighted MRI at 3 Tesla for localizing prostate cancer: correlation with whole-mount histopathology. J Magn Reson Imaging 39(6):1443–1448
Lourenco AP, et al. (2014) Improving outcomes of screening breast MRI with practice evolution: initial clinical experience with 3T compared to 1.5T. J Magn Reson Imaging 39(3):535–539
Torricelli P, et al. (2008) 3-T MRI with phased-array coil in local staging of prostatic cancer. Acad Radiol 15(9):1118–1125
Costa DN, et al. (2016) Comparison of prostate cancer detection at 3-T MRI with and without an endorectal coil: a prospective, paired-patient study. Urol Oncol. doi:10.1016/j.urolonc.2016.02.009
Weinreb JC, et al. (2016) PI-RADS prostate imaging: reporting and data system: 2015, Version 2. Eur Urol 69(1):16–40
Dwivedi DK, et al. (2016) Stratification of the aggressiveness of prostate cancer using pre-biopsy multiparametric MRI (mpMRI). NMR Biomed 29:232–238
Muller BG, et al. (2015) Prostate cancer: interobserver agreement and accuracy with the revised prostate imaging reporting and data system at multiparametric MR imaging. Radiology 277(3):741–750
Weinreb JC, et al. (2009) Prostate cancer: sextant localization at MR imaging and MR spectroscopic imaging before prostatectomy–results of ACRIN prospective multi-institutional clinicopathologic study. Radiology 251(1):122–133
Park SY, et al. (2016) Prostate cancer: PI-RADS version 2 helps preoperatively predict clinically significant cancers. Radiology 2:151133
Rastinehad AR, et al. (2016) Reproducibility of multiparametric MRI and fusion-guided prostate biopsy: multi-institutional external validation by a propensity score matched cohort. J Urol. doi:10.1016/j.juro.2015.12.102
George AK, Pinto PA, Rais-Bahrami S (2014) Multiparametric MRI in the PSA screening era. Biomed Res Int 2014:465816
Kongnyuy M, et al. (2015) A case of In-bore transperineal MRI-guided prostate biopsy of a patient with ileal pouch-anal anastomosis. Case Rep Urol 2015:676930
Kwak JT, et al. (2015) Is visual registration equivalent to semiautomated registration in prostate biopsy? Biomed Res Int 2015:394742
Kongnyuy M, et al. (2016) Magnetic resonance imaging-ultrasound fusion-guided prostate biopsy: review of technology, techniques, and outcomes. Curr Urol Rep 17(4):32
Sonn GA, et al. (2014) Initial experience with electronic tracking of specific tumor sites in men undergoing active surveillance of prostate cancer. Urol Oncol 32(7):952–957
Sankineni S, et al. (2015) Posterior subcapsular prostate cancer: identification with mpMRI and MRI/TRUS fusion-guided biopsy. Abdom Imaging 40(7):2557–2565
Kongnyuy M, Sidana A, George AK, et al. (2016) The significance of anterior prostate lesions on multiparametric magnetic resonance imaging in African American men. Urol Oncol. doi:10.1016/j.urolonc.2015.12.018
Delongchamps NB, et al. (2013) Prebiopsy magnetic resonance imaging and prostate cancer detection: comparison of random and targeted biopsies. J Urol 189(2):493–499
Vourganti S, et al. (2012) Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol 188(6):2152–2157
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474
Muller BG, et al. (2015) Multiparametric magnetic resonance imaging-transrectal ultrasound fusion-assisted biopsy for the diagnosis of local recurrence after radical prostatectomy. Urol Oncol 33(10):425.e1–425.e6
Gupta RT, et al. (2014) Comparing 3-T multiparametric MRI and the partin tables to predict organ-confined prostate cancer after radical prostatectomy. Urol Oncol 32(8):1292–1299
Raskolnikov D, et al. (2015) The role of magnetic resonance image guided prostate biopsy in stratifying men for risk of extracapsular extension at radical prostatectomy. J Urol 194(1):105–111
Raskolnikov D, et al. (2014) Multiparametric magnetic resonance imaging and image-guided biopsy to detect seminal vesicle invasion by prostate cancer. J Endourol 28(11):1283–1289
Thoeny HC, et al. (2014) Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology 273(1):125–135
Saokar A, et al. (2010) Detection of lymph nodes in pelvic malignancies with computed tomography and magnetic resonance imaging. Clin Imaging 34(5):361–366
Lecouvet FE, et al. (2012) Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99 m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Eur Urol 62(1):68–75
Hovels AM, et al. (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395
Carlin BI, Andriole GL (2000) The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma. Cancer 88(12 Suppl):2989–2994
Bjurlin MA, et al. (2015) Imaging and evaluation of patients with high-risk prostate cancer. Nat Rev Urol 12(11):617–628
Network (2016) N.C.C. NCCN guidelines version 2.2016 prostate cancer. www.NCCN.org
Damle NA, et al. (2013) The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan. Jpn J Radiol 31(4):262–269
Langsteger W, et al. (2012) Imaging of bone metastases in prostate cancer: an update. Q J Nucl Med Mol Imaging 56(5):447–458
Perlmutter MA, Lepor H (2007) Androgen deprivation therapy in the treatment of advanced prostate cancer. Rev Urol 9(Suppl 1):S3–S8
Hawkins T, Halewood MM (2008) Technical note: identifying the prostate cancer ‘superscan’ by quantitative skeletal scintigraphy. Nucl Med Commun 29(7):654–659
Buckley O, et al. (2007) 99mTc bone scintigraphy superscans: a review. Nucl Med Commun 28(7):521–527
Leung D, et al. (2014) Imaging approaches with advanced prostate cancer: techniques and timing. Can J Urol 21(2 Supp 1):42–47
Ghanem N, et al. (2005) Diagnostic value of MRI in comparison to scintigraphy, PET, MS-CT and PET/CT for the detection of metastases of bone. Eur J Radiol 55(1):41–55
Shen G, et al. (2014) Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skeletal Radiol 43(11):1503–1513
Mitchell CR, et al. (2013) Operational characteristics of (11)c-choline positron emission tomography/computerized tomography for prostate cancer with biochemical recurrence after initial treatment. J Urol 189(4):1308–1313
Evangelista L, et al. (2013) Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol 63(6):1040–1048
Evangelista L, et al. (2013) Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med 38(5):305–314
Turkbey B, et al. (2015) Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer. CA Cancer J Clin. doi:10.3322/caac.21333
Park BH, et al. (2014) Influence of magnetic resonance imaging in the decision to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. J Urol 192(1):82–88
Tabatabaei S, et al. (2011) Prostate cancer imaging: what surgeons, radiation oncologists, and medical oncologists want to know. AJR Am J Roentgenol 196(6):1263–1266
Natarajan S, et al. (2015) Focal laser ablation of prostate cancer: phase I clinical trial. J Urol. doi:10.1016/j.juro.2015.12.083
Jarow JP, et al. (2015) Partial gland ablation for prostate cancer: report of a Food and Drug Administration, American Urological Association, and Society of Urologic Oncology Public Workshop. Urology. doi:10.1016/j.urology.2015.11.018
Ghai S, et al. (2015) Real-time MRI-guided focused ultrasound for focal therapy of locally confined low-risk prostate cancer: feasibility and preliminary outcomes. AJR Am J Roentgenol 205(2):W177–W184
Ahmed HU, et al. (2015) Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol 68(6):927–936
Okoro C, et al. (2015) Magnetic resonance imaging/transrectal ultrasonography fusion prostate biopsy significantly outperforms systematic 12-core biopsy for prediction of total magnetic resonance imaging tumor volume in active surveillance patients. J Endourol 29(10):1115–1121
WaltonDiaz A, et al. (2015) Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance. Urol Oncol 33(5):202.e1–202.e7
Raskolnikov D, et al. (2015) The role of image guided biopsy targeting in patients with atypical small acinar proliferation. J Urol 193(2):473–478
Chelluri R, et al. (2016) Prostate cancer diagnosis on repeat MRI-TRUS Fusion biopsy of benign lesions: recommendations for repeat sampling. J Urol. doi:10.1016/j.juro.2016.02.066
Hu JC, et al. (2014) Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply? J Urol 192(2):385–390
Moyer VA (2012) Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 157(2):120–134
Wysock JS, et al. (2016) Predictive value of negative 3T multiparametric prostate MRI on 12 core biopsy results. BJU Int. doi:10.1111/bju.13427
GrenaboBergdahl A, et al. (2015) Role of magnetic resonance imaging in prostate cancer screening: a pilot study within the Goteborg randomised screening trial. Eur Urol. doi:10.1016/j.eururo.2015.12.006
Shakir NA, et al. (2014) Identification of threshold prostate specific antigen levels to optimize the detection of clinically significant prostate cancer by magnetic resonance imaging/ultrasound fusion guided biopsy. J Urol 192(6):1642–1648
Fascelli M, et al. (2015) Combined biparametric prostate MRI and prostate specific antigen in the detection of prostate cancer: a validation study in a biopsy naive patient population. Urology. doi:10.1016/j.urology.2015.09.035
Ciccarese C, et al. (2016) Metabolic alterations in renal and prostate cancer. Curr Drug Metab 17(2):150–155
Albers MJ, et al. (2008) Hyperpolarized 13C lactate, pyruvate, and alanine: noninvasive biomarkers for prostate cancer detection and grading. Cancer Res 68(20):8607–8615
Nelson SJ, et al. (2013) Metabolic imaging of patients with prostate cancer using hyperpolarized [1-(1)(3)C]pyruvate. Sci Trans Med 5(198):198ra108
Postema A, et al. (2015) Multiparametric ultrasound in the detection of prostate cancer: a systematic review. World J Urol 33(11):1651–1659
Kuenen MP, et al. (2013) Contrast-ultrasound dispersion imaging for prostate cancer localization by improved spatiotemporal similarity analysis. Ultrasound Med Biol 39(9):1631–1641
Eckersley RJ, et al. (2002) Quantitative microbubble enhanced transrectal ultrasound as a tool for monitoring hormonal treatment of prostate carcinoma. Prostate 51(4):256–267
Ahmad S, et al. (2013) Transrectal quantitative shear wave elastography in the detection and characterisation of prostate cancer. Surg Endosc 27(9):3280–3287
Haseman MK, Reed NL, Rosenthal SA (1996) Monoclonal antibody imaging of occult prostate cancer in patients with elevated prostate-specific antigen. Positron emission tomography and biopsy correlation. Clin Nucl Med 21(9):704–713
Barrett JA, et al. (2013) First-in-man evaluation of 2 high-affinity PSMA-avid small molecules for imaging prostate cancer. J Nucl Med 54(3):380–387
Rowe SP, et al. (2016) Comparison of prostate-specific membrane antigen-based 18F-DCFBC PET/CT to conventional imaging modalities for detection of hormone-naive and castration-resistant metastatic prostate cancer. J Nucl Med 57(1):46–53
Maurer T, et al. (2015) Diagnostic Efficacy of Gallium-PSMA positron emission tomography compared to conventional imaging in lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol. doi:10.1016/j.juro.2015.12.025
Dietlein M, et al. (2015) Comparison of [(18)F]DCFPyL and [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer. Mol Imaging Biol 17(4):575–584
Eiber M, et al. (2016) Simultaneous Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol. doi:10.1016/j.eururo.2015.12.053
Harisinghani MG, et al. (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348(25):2491–2499
Acknowledgments
This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research, and the Center for Interventional Oncology. NIH and Philips Healthcare have a cooperative research and development agreement. NIH and Philips share intellectual property in the field. This research was also made possible through the National Institutes of Health Medical Research Scholars Program, a public–private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from Pfizer Inc., The Doris Duke Charitable Foundation, The Alexandria Real Estate Equities, Inc. and Mr. and Mrs. Joel S. Marcus, and the Howard Hughes Medical Institute, as well as other private donors. For a complete list, please visit the Foundation website at: http://fnih.org/work/education-training-0/medical-research-scholars-program.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Arvin K. George, Baris Turkbey, Subin G. Valayil, Akhil Muthigi, Francesca Mertan, Michael Kongnyuy, and Peter A. Pinto declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
George, A.K., Turkbey, B., Valayil, S.G. et al. A urologist’s perspective on prostate cancer imaging: past, present, and future. Abdom Radiol 41, 805–816 (2016). https://doi.org/10.1007/s00261-016-0751-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-016-0751-6