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MR Imaging in Prostate Tumor Volume Assessment: How Accurate?

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Active Surveillance for Localized Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

Abstract

The current definition of clinically significant prostate cancer includes an indirect measure of the volume of prostate cancer in addition to Gleason score based on biopsy findings. This biopsy-based tumor volume measure lacks accuracy, and therefore assessment by MRI of prostate cancer tumor volume could have a beneficial role for men on active surveillance. Despite the advances in interpretation and reporting on prostate cancer identified on MRI, limited evidence is available on tumor volume measurements on MRI. Although the PI-RADS version 2 has made some effort to define lesion measurements, many factors may influence these measurements. The robustness of tumor size or tumor volume assessment is reduced especially in small lesions visible on MRI. Furthermore, the overlap of benign and malignant tissue may hamper the accuracy of volume measurements. Even more, the heterogeneity of the prostate cancer, as also shown by the different Gleason patterns within the tumor, may demonstrate differences in tumor visualization on MRI. Moreover, differences in MRI hardware, software, imaging protocols, the chosen sequence, and the chosen slice may each have some effect on the robustness of tumor volume measurements.

This review discusses the applicability in clinical setting of MRI tumor volume assessment. Based on comparison between preoperative MRI-derived and histology-confirmed tumor volumes on prostatectomy specimen, the MRI inaccurately estimates the index tumor volume, irrespective of actual tumor size, Gleason grade, and MRI suspicion score. Caution is warranted for present clinical application of MRI tumor volume measurements.

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Authors and Affiliations

  1. Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands

    Ivo G. Schoots

  2. Department of Radiology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Ivo G. Schoots

  3. Laboratory Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada

    Theo H. van der Kwast

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  1. Ivo G. Schoots
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  2. Theo H. van der Kwast
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Correspondence to Ivo G. Schoots .

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  1. University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Laurence Klotz

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Schoots, I.G., van der Kwast, T.H. (2018). MR Imaging in Prostate Tumor Volume Assessment: How Accurate?. In: Klotz, L. (eds) Active Surveillance for Localized Prostate Cancer. Current Clinical Urology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62710-6_10

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