Locally advanced prostate cancer imaging findings and implications for treatment from the surgical perspective

  • Sherif B. ElsherifEmail author
  • Vishnupriya Kuchana
  • Rizwan Aslam
  • Ashish Kamat
  • Priya R. Bhosale
  • A. R. Klekers


The anatomy of the prostate is reviewed in the context of discussing the staging of prostate cancer and patterns of tumor spread. The utility of prostate magnetic resonance imaging along with new advancements in tumor staging are discussed specifically in locally advanced disease. What should be included in the radiology report carries a substantial weight to formulate the urologist’s decision in regards to the selection of surgical candidates, preoperative planning and avoiding postoperative complications.


Prostate cancer MpMRI Locally advanced disease Staging PI-RADS 


Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.


  1. 1.
    Hernandez G, Ramirez JL, Pedroza-Torres A, Herrera LA, Jimenez-Rios MA (2019) The Secret Life of Translation Initiation in Prostate Cancer. Frontiers in genetics 10:14. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kirby RS, Partin, A. W., Parsons, J. K., & Feneley, M. R (2008) Treatment methods for early and advanced prostate cancer. CRC PressGoogle Scholar
  3. 3.
    Key Statistics for Prostate Cancer | Prostate Cancer Facts. Available at: (Accessed: 20th June 2018) Accessed 20th June 2018
  4. 4.
    Attard G, Parker C, Eeles RA, Schroder F, Tomlins SA, Tannock I, Drake CG, de Bono JS (2016) Prostate cancer. Lancet 387 (10013):70-82. CrossRefPubMedGoogle Scholar
  5. 5.
    Mazaheri Y S-DA, Muellner A, Hricak H. (20008) MR imaging of the prostate in clinical practice. Epub 2008 Sep 16Google Scholar
  6. 6.
    Tan CH, Wang J, Kundra V (2011) Diffusion weighted imaging in prostate cancer. Eur Radiol 21 (3):593-603. CrossRefPubMedGoogle Scholar
  7. 7.
    Czarniecki M, Jakucinski M, Krolicki L (2016) Prostate MRI - an update for the referring urologist. Cent European J Urol 69 (2):162-169. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Lahoti AM, Dhok AP, Rantnaparkhi CR, Rawat JS, Chandak NU, Tawari HS (2017) Role of Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy and Transrectal Ultrasound in Evaluation of Prostatic Pathologies with Focus on Prostate Cancer. Polish journal of radiology 82:827-836. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Loffroy R, Chevallier O, Moulin M, Favelier S, Genson PY, Pottecher P, Crehange G, Cochet A, Cormier L (2015) Current role of multiparametric magnetic resonance imaging for prostate cancer. Quantitative imaging in medicine and surgery 5 (5):754-764. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Scialpi M, D’Andrea A, Martorana E, Malaspina CM, Aisa MC, Napoletano M, Orlandi E, Rondoni V, Scialpi P, Pacchiarini D, Palladino D, Dragone M, Di Renzo G, Simeone A, Bianchi G, Brunese L (2017) Biparametric MRI of the prostate. Turkish journal of urology 43 (4):401-409. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Frederic H. Martini MJT, Michael P. Mckinley (2000) Human Anatomy. True heart (Third edition)Google Scholar
  12. 12.
    Keith L. Moore AFD (1999) Clinically Oriented Anatomy, vol 4. MD: Lippincott Williams and WilkinsGoogle Scholar
  13. 13.
    Kundra V, Silverman PM, Matin SF, Choi H (2007) Imaging in oncology from the University of Texas M. D. Anderson Cancer Center: diagnosis, staging, and surveillance of prostate cancer. AJR Am J Roentgenol 189 (4):830-844. CrossRefGoogle Scholar
  14. 14.
    Verla W, Oosterlinck W, Spinoit AF, Waterloos M (2019) A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. Biomed Res Int 2019:9046430. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wirth MP, Hakenberg OW, Froehner M (2007) Optimal treatment of locally advanced prostate cancer. World J Urol 25 (2):169-176. CrossRefPubMedGoogle Scholar
  16. 16.
    Amin MB, Edge SB (2017) AJCC cancer staging manual. Springer,Google Scholar
  17. 17.
    McNeal JE, Redwine EA, Freiha FS, Stamey TA (1988) Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 12 (12):897-906CrossRefGoogle Scholar
  18. 18.
    Stratton KL, Chang SS (2009) Locally advanced prostate cancer: the role of surgical management. BJU Int 104 (4):449-454. CrossRefPubMedGoogle Scholar
  19. 19.
    Buyyounouski MK, Choyke PL, McKenney JK, Sartor O, Sandler HM, Amin MB, Kattan MW, Lin DW (2017) Prostate cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 67 (3):245-253. Google Scholar
  20. 20.
    Pesapane F, Czarniecki M, Suter MB, Turkbey B, Villeirs G (2018) Imaging of distant metastases of prostate cancer. Med Oncol 35 (11):148. CrossRefPubMedGoogle Scholar
  21. 21.
    Mattei A, Fuechsel FG, Bhatta Dhar N, Warncke SH, Thalmann GN, Krause T, Studer UE (2008) The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 53 (1):118-125. CrossRefPubMedGoogle Scholar
  22. 22.
    Heindel W, Gübitz R, Vieth V, Weckesser M, Schober O, Schäfers M (2014) The diagnostic imaging of bone metastases. Deutsches Arzteblatt international 111 (44):741-747. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Van Poppel H, Vekemans K, Da Pozzo L, Bono A, Kliment J, Montironi R, Debois M, Collette L (2006) Radical prostatectomy for locally advanced prostate cancer: results of a feasibility study (EORTC 30001). Eur J Cancer 42 (8):1062-1067. CrossRefPubMedGoogle Scholar
  24. 24.
    Soulié M (2008) What is the role of surgery for locally advanced disease? 7 (5):400-405Google Scholar
  25. 25.
    Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, Canby-Hagino E, Crawford ED (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181 (3):956-962. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kibel AS, Rosenbaum E, Kattan MW, Picus J, Dreicer R, Klein EA, Chatta GS, Nelson JB, DiPaola RS, Roth BJ, Cookson MS, Wilding G, Jarrard DF, Beer TM, Ryan CW, Petrylak DP, Benson MC, Partin AW, Garrett-Mayer E, Eisenberger MA (2007) Adjuvant weekly docetaxel for patients with high risk prostate cancer after radical prostatectomy: a multi-institutional pilot study. J Urol 177 (5):1777-1781. CrossRefPubMedGoogle Scholar
  27. 27.
    Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, Tempany CM, Choyke PL, Cornud F, Margolis DJ, Thoeny HC, Verma S, Barentsz J, Weinreb JC (2019) Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. CrossRefGoogle Scholar
  28. 28.
    Rouviere O, Moldovan PC (2019) The current role of prostate multiparametric magnetic resonance imaging. Asian journal of urology 6 (2):137-145. CrossRefPubMedGoogle Scholar
  29. 29.
    Jacobs MA, Ouwerkerk R, Petrowski K, Macura KJ (2008) Diffusion-weighted imaging with apparent diffusion coefficient mapping and spectroscopy in prostate cancer. Top Magn Reson Imaging 19 (6):261-272. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Katelaris NC, Bolton DM, Weerakoon M, Toner L, Katelaris PM, Lawrentschuk N (2015) Current role of multiparametric magnetic resonance imaging in the management of prostate cancer. Korean J Urol 56 (5):337-345. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Hegde JV, Mulkern RV, Panych LP, Fennessy FM, Fedorov A, Maier SE, Tempany CM (2013) Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging 37 (5):1035-1054. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM (2016) Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 70 (2):233-245. CrossRefPubMedGoogle Scholar
  33. 33.
    McEvoy SH, Raeside MC, Chaim J, Ehdaie B, Akin O (2018) Preoperative Prostate MRI: A Road Map for Surgery. AJR Am J Roentgenol 211 (2):383-391. CrossRefPubMedGoogle Scholar
  34. 34.
    Futterer JJ, Barentsz J, Heijmijnk ST (2009) Imaging modalities for prostate cancer. Expert Rev Anticancer Ther 9 (7):923-937. CrossRefPubMedGoogle Scholar
  35. 35.
    Castiglione F, Ralph DJ, Muneer A (2017) Surgical Techniques for Managing Post-prostatectomy Erectile Dysfunction. Current urology reports 18 (11):90. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kim CK, Choi D, Park BK, Kwon GY, Lim HK (2008) Diffusion-weighted MR imaging for the evaluation of seminal vesicle invasion in prostate cancer: initial results. J Magn Reson Imaging 28 (4):963-969. CrossRefPubMedGoogle Scholar
  37. 37.
    Kongnyuy M, Sidana A, George AK, Muthigi A, Iyer A, Ho R, Chelluri R, Mertan F, Frye TP, Su D, Merino MJ, Choyke PL, Wood BJ, Pinto PA, Turkbey B (2017) Tumor contact with prostate capsule on magnetic resonance imaging: A potential biomarker for staging and prognosis. Urol Oncol 35 (1):30 e31-30 e38. CrossRefGoogle Scholar
  38. 38.
    Aiken WD, Chin W (2015) Surgical access for radical retropubic prostatectomy in the phenotypically narrow and steep black male’s pelvis is exacerbated by a posterior pubic symphyseal protuberance: A case report. Int J Surg Case Rep 13:88-90. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Caglic I, Kovac V, Barrett T (2019) Multiparametric MRI - local staging of prostate cancer and beyond. Radiology and oncology 53 (2):159-170. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Jansen BHE, Oudshoorn FHK, Tijans AM, Yska MJ, Lont AP, Collette ERP, Nieuwenhuijzen JA, Vis AN (2018) Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve. World J Urol 36 (9):1409-1415. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Zarzour JG, Galgano S, McConathy J, Thomas JV, Rais-Bahrami S (2017) Lymph node imaging in initial staging of prostate cancer: An overview and update. World journal of radiology 9 (10):389-399. CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Alberto Briganti MB, James H. Eastham, Markus Graefen, Axel Heindenreich, Jeffrey R. Karnes, Francesco Montorsi, Urs E. Studer (2009) Pelvic Lymph Node Dissection in Prostate Cancer. vol 55, 6 edn., European Urology. doi: CrossRefGoogle Scholar
  43. 43.
    Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, Severens JL, Barentsz JO (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. CrossRefPubMedGoogle Scholar
  44. 44.
    Thoeny HC, Froehlich JM, Triantafyllou M, Huesler J, Bains LJ, Vermathen P, Fleischmann A, Studer UE (2014) Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology 273 (1):125-135. CrossRefPubMedGoogle Scholar
  45. 45.
    Meeks JJ, Eastham JA (2013) Radical prostatectomy: positive surgical margins matter. Urol Oncol 31 (7):974-979. CrossRefPubMedGoogle Scholar
  46. 46.
    Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R, Touijer K (2014) Positive Surgical Margins After Radical Prostatectomy: A Systematic Review and Contemporary Update. Eur Urol 65 (2):303-313. CrossRefPubMedGoogle Scholar
  47. 47.
    Matikainen MP, von Bodman CJ, Secin FP, Yunis LH, Vora K, Guillonneau B, Laudone V, Eastham JA, Scardino PT, Akin O, Rabbani F (2010) The depth of the prostatic apex is an independent predictor of positive apical margins at radical prostatectomy. BJU Int 106 (5):622-626. CrossRefPubMedGoogle Scholar
  48. 48.
    Hong SK, Poon BY, Sjoberg DD, Scardino PT, Eastham JA (2014) Prostate Size and Adverse Pathologic Features in Men Undergoing Radical Prostatectomy. Urology 84 (1):153-157. CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Garvey B, Turkbey B, Truong H, Bernardo M, Periaswamy S, Choyke PL (2014) Clinical value of prostate segmentation and volume determination on MRI in benign prostatic hyperplasia. Diagn Interv Radiol 20 (3):229-233. CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Jeong CW, Lee S, Oh JJ, Lee BK, Lee JK, Jeong SJ, Hong SK, Byun SS, Choe G, Lee SE (2014) Quantification of median lobe protrusion and its impact on the base surgical margin status during robot-assisted laparoscopic prostatectomy. World J Urol 32 (2):419-423. CrossRefPubMedGoogle Scholar
  51. 51.
    Jo JK, Hong SK, Byun SS, Zargar H, Autorino R, Lee SE (2016) Urinary Continence after Robot-Assisted Laparoscopic Radical Prostatectomy: The Impact of Intravesical Prostatic Protrusion. Yonsei Med J 57 (5):1145-1151. CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    von Bodman C, Matsushita K, Savage C, Matikainen MP, Eastham JA, Scardino PT, Rabbani F, Akin O, Sandhu JS (2012) Recovery of urinary function after radical prostatectomy: predictors of urinary function on preoperative prostate magnetic resonance imaging. J Urol 187 (3):945-950. CrossRefGoogle Scholar
  53. 53.
    Coakley FV, Eberhardt S, Kattan MW, Wei DC, Scardino PT, Hricak H (2002) Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol 168 (3):1032-1035. CrossRefPubMedGoogle Scholar
  54. 54.
    Rosenkrantz AB, Shanbhogue AK, Wang A, Kong MX, Babb JS, Taneja SS (2016) Length of capsular contact for diagnosing extraprostatic extension on prostate MRI: Assessment at an optimal threshold. J Magn Reson Imaging 43 (4):990-997. CrossRefPubMedGoogle Scholar
  55. 55.
    Matin SF (2006) Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy. Urology 67 (5):1012-1015. CrossRefPubMedGoogle Scholar
  56. 56.
    Secin FP, Touijer K, Mulhall J, Guillonneau B (2007) Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol 51 (5):1229-1235. CrossRefPubMedGoogle Scholar
  57. 57.
    Rogers CG, Trock BP, Walsh PC (2004) Preservation of accessory pudendal arteries during radical retropubic prostatectomy: surgical technique and results. Urology 64 (1):148-151. CrossRefPubMedGoogle Scholar
  58. 58.
    Eastham JA, Schaeffer EM (2013) Radical prostatectomy: surgical perspectives. Springer Science & Business Media,Google Scholar
  59. 59.
    Elmi A, Tabatabaei S, Talab SS, Hedgire SS, Cao K, Harisinghani M (2012) Incidental findings at initial imaging workup of patients with prostate cancer: clinical significance and outcomes. AJR Am J Roentgenol 199 (6):1305-1311. CrossRefPubMedGoogle Scholar
  60. 60.
    Sherrer RL, Lai WS, Thomas JV, Nix JW, Rais-Bahrami S (2018) Incidental findings on multiparametric MRI performed for evaluation of prostate cancer. Abdom Radiol (NY) 43 (3):696-701. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Internal Medicine, Weiss Memorial HospitalAffiliate of the University of Illinois at ChicagoChicagoUSA
  3. 3.Department of Urology, Division of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations