Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a useful modality for the precise detection and staging of early prostate cancer

Abstract

BACKGROUND The aim of this study was to visualize early stage prostate cancer (Cap) in a clinical setting. In previous studies, the results of magnetic resonance imaging (MRI) for screening Cap have rarely been confirmed by well‐designed multisite prostate biopsy. METHODS The prostate glands of 90 men with elevated prostate‐specific antigen (PSA) were imaged by dynamic contrast‐enhanced MRI (DCE‐MRI) before transrectal ultrasound‐guided 14‐cores prostate biopsy. Each core was divided into three subcore fractions (total of 42 fractions) to generate a histological localization diagram, which was compared with localization‐visualized DCE‐MRI. RESULTS The detection rate of Cap in 57 patients with PSA < 10.0 ng/ml was 36.8% as determined by the initial biopsy. DCE‐MRI uncovered 92.9% of the clinically significant Caps and its specificity was 96.2% for the first biopsy session. One case with positive DCE‐MRI and a negative primary biopsy was positive with additional biopsies. All of 26 DCE‐MRI positive cases had significant Cap, and two of eight patients with histological Cap and negative or equivocal imaging had significant cancer. In total, 9 of 20 cases with DCE‐MRI stage T2 underwent radical prostatectomy. All of them had organ‐confined disease, although 33–77% (mean 63%) of them were expected to be rated T3 or higher by Partin's table. CONCLUSIONS DCE‐MRI can identify early stage Cap with high sensitivity and specificity, and can predict the histological grade to some extent. DCE‐MRI prior to biopsy should be applied to younger patients with surgical indications. Otherwise, we recommend the definitive diagnosis of Cap by utilizing DCE‐MRI alone.