Advances in imaging are making diagnosis and characterization of prostate cancer much more accurate—in both early and later stages of the disease.
"We’ve been limited in our ability to visualize prostate cancer for many years,” says Rajan T. Gupta, MD, director of imaging at the Prostate & Urologic Cancers Center within the Duke Cancer Center. "But prostate MRI has given us the opportunity to not only find the cancers but to characterize them. It allows us to visualize cancer inside the gland and guide the biopsy so that it can be more directed and informative of the patient’s actual condition."
Prostate cancer diagnosis has historically relied on ultrasound-guided biopsy to identify which tissues to obtain samples from, but the technique often results in underestimating the stage or missing the cancer entirely. The advantage of adding MRI for image-guided targeted biopsy is that it can provide important staging information as to whether the cancer has permeated through the capsule, invaded the seminal vesicles, or metastasized to the lymph nodes.
A recent study concluded that image-guided biopsy is associated with increased detection of clinically significant prostate cancer and decreased detection of low-grade prostate cancer compared with standard biopsy. "By better characterizing these cancers, we have a much better ability to understand what the disease burden is and determine the appropriate treatment," Gupta says.
Patients with advanced cancer also have a new imaging option that identifies a protein on the surface of prostate cancer cells known as prostate-specific membrane antigen or PSMA. The molecular imaging technique—called PSMA PET—can identify if and where the cancer has metastasized.
Duke’s distinctive approach to prostate cancer extends beyond the advanced equipment, Gupta says. The key is combining the technology with experienced subspecialists who know which test to use, how to interpret results, and how best to tailor treatment.
In addition to offering state-of-the-art imaging on Duke’s main campus, facilities like the ambulatory Duke Imaging Arringdon center that recently opened in Morrisville also offer the more powerful three-Tesla MRI. The imaging center offers a convenient setting for the patient, and the images will still be “interpreted by subspecialty experts who have dedicated training,” Gupta says.
"These subspecialists have a knowledge base built on reading thousands of MRIs per year. More accurately diagnosing, characterizing, and staging prostate cancer allows us to personalize treatment and deliver multidisciplinary care across all levels," Gupta says.