At Rolling Oaks Radiology, we are at the forefront of Prostate imaging.  Rolling Oaks was selected as a beta site by Invivo Corporation to help validate and develop their MRI computer assisted detection software and MRI guided biopsy device, which received FDA approval in September of 2009. We perform the highest quality prostate MRI of any center in southern California . We utilize a Philips super high field, 3Tesla MRI unit, with the highest level of gradient strength and software in conjunction with the Dynacad Prostate CAD system. Additionally, we are the only center at this time capable of performing MRI directed prostate biopsy if a suspicious focus is identified on the detection phase of MRI imaging.

            190,000 men are diagnosed each year in our country with Prostate cancer, and roughly 28,000 men die of the disease. These statistics mirror almost exactly similar numbers for women with breast cancer. However, most women obtain annual mammograms, and are more aware about the benefits of appropriate screening for early cancer detection. Men rely on two very insensitive tests: the PSA blood test and digital rectal exam.

            The standard treatment for men who have an unexplained elevated PSA blood test is to be referred to a Urologist for a Trans Rectal Ultrasound (TRUS), and biopsy. The cancer detection rate with this strategy is relatively low; less than 25%. There are two reasons for this low specificity: that the prostate gland may not contain cancer, so the biopsy will be negative, or the biopsy missed a cancer due to sample problems.  After this scenario, most men are offered ‘active surveillance’, which means they wait one year, have a repeat PSA blood test, and another TRUS biopsy. The yield for second biopsy for cancer detection after a negative first biopsy for men with PSA levels less than 10 is only 20%.

            There is a relatively new additional diagnostic study that has been proven to be more sensitive and specific for the early detection of prostate disease, this test is Prostate MRI. Prostate MRI has been utilized since the early 1990’s, but due to low diagnostic accuracy it fell out of favor. What has changed?

            Some centers have dedicated Prostate MRI programs using a multi-parametric approach to imaging, which has shown increased sensitivity and specificity for cancer detection to around 85-90%. These improved results are based by combined analysis of 4 specific imaging sequences. These include high anatomic quality T-2 weighted imaging, and three functional sequences. The functional sequences include diffusion weighted imaging(DWI),  dynamic contrast enhancement (DCE) and MRI spectroscopy.  DWI analyzes the restriction of movement of water molecules seen with prostate cancer.  DCE is performed with intravenous contrast administration to evaluate increased and abnormal blood vessels seen with prostate cancer.  These DCE images are obtained rapidly and analyzed with computer generated curves which look for increased flow and rapid washout.  MRI spectroscopy looks for the change in the chemical components seen with prostate cancer, with a decrease in the normal citrate and an increase in choline molecules.

We offer several pathways for patients to be candidates for Prostate MRI:

            The first pathway access is for patients who have an unexplained serum PSA, and have had at least one negative TRUS biopsy performed by a Urologist.  For these men, we offer a Prostate cancer detection screen on the 3T magnet.   T-2 , DCE and DWI sequences are used to image  the prostate.  We do not feel the need to use an endorectal coil with our superior equipment to evaluate whether a patient’s prostate gland has a hidden cancer, or is normal.

            The second pathway is for men who have had a positive TRUS biopsy; and know they have prostate cancer. We offer a STAGING protocol for them. This includes the above protocols, but also uses an endorectal coil for even more improved resolution, and we also add MRI spectroscopy. We can accurately measure the size, extent, and activity of the tumor.  We also determine and describe whether the cancer is contained the gland, or whether there is extension beyond the capsule of the gland. If the tumor has spread significantly beyond the capsule of the gland, most of these men are no longer appropriate candidates for radical prostatectomy surgery or robotic surgery, and are best treated with Radiation Therapy. Instead of having men also sent for staging CT scans of their abdomen and pelvis looking for spread of disease; and a bone scan; we feel we can improve our sensitivity with a better and different strategy. We also perform a ‘Bones and Lymph Node’ staging MRI of the pelvis, lumbar spine and thoracic spine, and don’t perform the CT scan and bone scan. However, if a patient has a high grade Gleason score prostate cancer and large volume disease, we would also recommend a bone scan.

            The third pathway is for men who have been previously treated for prostate cancer with either surgery or radiation and have a PSA relapse.  MRI is useful to help identify where and how big a recurrent or metastatic focus of prostate cancer they may have.

            If you, or a friend or loved one has an elevated PSA, has had a negative ultrasound directed prostate biopsy and are interested in learning more about the advanced prostate cancer detection program offered by Rolling Oaks; please feel free to email questions, or call the prostate experts.  Drs. Robert Princenthal, and Martin Cohen are the directors of this program; and will be pleased to share their expertise with you.

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