Advanced prostate imaging is performed through magnetic resonance imaging (MRI), which uses powerful magnets and radio waves to create detailed images of the prostate. Appropriate treatment recommendations for prostate cancer are based on knowing the accurate staging of the tumor. During a non-invasive examination, specialists perform multiple advanced imaging techniques, which when evaluated together, can with a high-degree of accuracy detect and locate prostate cancer.
Referring physicians and patients visit Advanced Prostate Imaging at VCU Health for appointment information.
Advanced Prostate Imaging Techniques
The VCU Department of Radiology's Advanced Prostate Imaging team uses multiple non-invasive advanced prostate MR imaging techniques. These advanced prostate imaging techniques include T2-weighted MR imaging, MR diffusion and dynamic contrast enhanced imaging at our VCU Health 3T MR center. Based on published studies and our own experience, the combination of these techniques produce a high-level of accuracy, up to 90%, in the diagnosis of prostate cancer.
T2-weighted MR imaging provides high sensitivity and excellent demonstration of zonal anatomy and pathological processes of the prostate. The internal anatomy of the prostate demonstrates excellent differential soft tissue contrast on T2-weighted images.
The signal intensity of the normal peripheral zone is very high on T2 owing to its higher water content. If the prostate cancer is in the peripheral zone, a low signal intensity focus is always present on T2-weighted image resulting in a high sensitivity of detection.
The specificity of the low T2 signal foci in the peripheral zone is not highly accurate, about 70%, since these low signal foci may be seen in patients with focal infection, inflammation, bleeding or post treatment changes.
Diffusion-weighted MR imaging is sensitive to the structure of biological tissue at the microscopic level. The cancer lesion often has a high cellularity that limits the movement of water molecules within the lesion. With prostate cancer, a lesion usually appears dark on apparent diffusion coefficient (ADC) maps indicating diffusion restriction while normal tissue appears bright.
Dynamic contrast-enhanced MR Imaging is a powerful tool in providing a map of blood flow of prostate gland, which is increased in prostate cancer. In recent studies, DCE-MRI of the prostate gland has been shown to provide excellent enhanced imaging that is useful for both the detection and staging of prostate cancer with the specificity of DCE at approximately 85%.
MRI-ultrasound fusion-guided prostate biopsies overlay two images – one from the MRI, the other from the ultrasound – for an enhanced, highly improved view of the prostate. We are the only site in the Commonwealth of Virginia that performs advanced MRI-Ultrasound Fusion biopsies, which has simplified and shortened the biopsy process to about 20 minutes from what previously took nearly an hour.
Candidates for systematic biopsy guided with transrectal ultrasonography (US) are patients with PSA levels greater than 4 ng/mL or with suspicious findings at digital rectal examination. However, results from the first prostate biopsy are negative in an estimated 66% of patients with PSA levels greater than 4 ng/mL. Thus, a repeat biopsy are often required even though the positive rate of repeat biopsy, is only 15 to 20%.
MRI-ultrasound fusion-guided prostate biopsy allows precise placement of the biopsy needle into the target under direct vision by real time ultrasound which is fused with the pre-existing MR imaging. MR/US fusion guided biopsy of prostate cancer has been proven to be an accurate tool (positive yield up to 85%) in confirming the diagnosis of prostate cancer. It is particularly useful for patients with prior negative transrectal US guided biopsies.
A study published in 2015 by the Center for Cancer Research found that fusion biopsy is 30 percent more accurate in diagnosing high-risk, aggressive cancers than a TRUS biopsy.
A Transrectal Ultrasound (TRUS) biopsy procedure uses sound waves to make an image of the prostate on a video screen in order to guide biopsy needles into the appropriate area of the prostate. Using the ultrasound image, a physician quickly inserts a thin, hollow needle through the wall of the rectum into the prostate gland. When the needle is pulled out, it removes a small cylinder (core) of prostate tissue.
Meet Our Faculty
The VCU Department of Radiology's Professor and Director of Oncologic and Prostate Imaging Jinxing Yu, M.D., Assistant Professor Sara G. Winks, M.D., and other specialized abdominal radiologists at VCU are highly trained in advanced imaging techniques and biopsies of the prostate gland. The team works closely with urologists and radiation oncologists to provide the latest, most advanced diagnostic tools for prostate imaging, resulting in more accurate detection of prostate cancers.