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UCLA Prostate Imaging and Treatment

UCLA Prostate Imaging and Treatment
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UCLA Prostate Imaging and Treatment

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  • Case Studies
    • Radiation Therapy
    • Small Volume Low Grade Disease
    • Active Surveillance
    • Example of Change to Nerve Sparing
    • Extracapsular Extension and Seminal Vesicle Invasion
    • Dynamic Contrast-Enhancement for Biochemical Failure
    • MR-Guided Targeted Biopsy
    • Benign Disease (Infertility)
  • Clinical Trials
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  • Research Publications
  • Case Studies
  • Clinical Trials
  • CME Course
  • Research Publications
  • Radiation Therapy
  • Small Volume Low Grade Disease
  • Active Surveillance
  • Example of Change to Nerve Sparing
  • Extracapsular Extension and Seminal Vesicle Invasion
  • Dynamic Contrast-Enhancement for Biochemical Failure
  • MR-Guided Targeted Biopsy
  • Benign Disease (Infertility)
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  5. Example of Change to Nerve Sparing

Example of Change to Nerve Sparing

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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

  1. Technical quality: excellent
  2. Left anterior lesion highly suspicious for aggressive disease may involve anterior capsule
  3. 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
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