Example of Change to Nerve Sparing
History
- 59 year-old
- PSA 4.3
- standard biopsy: 3+3=6 but large volume left
Imaging
LEFT: T2-weighted imaging: hypointense focus left anterior apex (horizontal arrow) with uninvolved neurovascular bundle (vertical arrow)
CENTER: Colorized apparent diffusion coefficient (ADC) map: moderately restricted diffusion (yellow arrow)
RIGHT: Colorized dynamic contrast enhanced (DCE) perfusion map: focal intense enhancement
Spectroscopic imaging: elevated choline (left peak) to citrate (right peak) ratios (blue arrows)
Example Report for This Case: Surgical Planning
* Findings
No suspicious lymph nodes or bone lesions. Prostate measures 38 gm with mild prostatic hyperplasia. A single suspicious area is identified:
| Location |
Left anterior central apex 2:00 |
| Capsule |
Bulges anteriorly only |
| T2 |
Asymmetric, ill-defined (4/5) |
| Diffusion |
ADC 0.82, highly restricted (4/5) |
| Perfusion |
Early and intense + washout (4/5) |
| Spectroscopy |
Abnormal |
| Overall Suspicion |
High (4/5) |
Seminal vesicles and neurovascular bundles appear normal.
* Impression
- Technical quality: excellent
- Left anterior lesion highly suspicious for aggressive disease may involve anterior capsule
- Organ-confined disease.
Result
Final Path: 3+4=7, T2c
Advantage: UCLA Prostate MRI
- In cases of suspected high volume but organ confined disease, MRI can help with the decision to spare one or both nerves and still achieve negative surgical margins
- Spectroscopic imaging is the most specific of the functional parameters of prostate MRI, but requires focused experience to accurately tune the magnet
