Prostate Imaging

Extracapsular Extension and Seminal Vesicle Invasion

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History

  • 59 year-old male.
  • PSA level: 10
  • Clinical staging: T1C
  • Blind systematic biopsy results: Gleason: 3+4=7 in the Left prostate

Imaging

Extracapsular Extension and Seminal Vesicle Invasion by MRI

LEFT: Axial T2-weighted image: low signal bulges the capsule (arrow)

RIGHT: Gray-scale apparent diffusion coefficient (ADC) map: focal restricted diffusion (arrow)

Coronal T2-weighted image and sample spectrum from spectroscopic imaging

LEFT: Coronal T2-weighted image: abnormal signal extends to seminal vesicles (arrow)

RIGHT: Sample spectrum from spectroscopic imaging: elevated choline (Cho) relative to citrate (Ci)

Results

  • Gleason Score 3+4 prostate cancer
    • Extra-capsular extension,
    • Left seminal vesicle invasion.
  • TNM staging : T3b

Advantage: UCLA Prostate MRI

For patients at intermediate risk of T3 disease, MRI can stratify risk.