8. The People's Prostate Flashcards
Prostatic adenoCA is commonly seen in what zone?
Central zone + Transitional zone =
Central gland
The most T2 bright zone
Peripheral zone
The prostate anatomy
The difference between the dark and bright stuff!
Picture of Prostate CA on MRI
Dark T2
+ Restricted diffusion (low ADC)
+ enhances early and washes out
How do you evaluate prostate mets?
Bone scan (Vertebral body)
Prostate cancer staging
Most important factor in staging
Extra capsular extension
Stage II vs Stage III Prostate CA
What is behind the prostate that can get invaded?
Seminal vesicles (T3b) and the. nerve bundle
Who Dies of Prostate Cancer ?
3 factors:
- Gleason Score 8-10
- Advanced Clincal stagen (mets)
- PSA > 20
Gleason scores less than 6, PSA < 10, and staging < 2a (less than half
the lobe) are unlikely to die of the prostate cancer.
Clinically Significant Cancer:
Gleason Score > 7
Cancer volume > 0.5 cc
Capsular extension
Capsular extension picture
Loss of normal T2 signal in the seminal vesicle
Bulging of the capsule
Loss of fat betwee prostate and rectum
Neurovascular bundle asymmetry
This is an antigen produced by the normal prostate and incorporated into the ejaculate for the purpose of dissolving cervical mucus etc
PSA
Normal < 4
Low Risk Category < 10
High Risk Category > 20.
Normal PSA after prostatectomy
0
If > 0.2 think recurrence
Post radiation = 2.0? = concerning for recurrence
< 20 = bone mets unlikely
The gleason score
Gleason score
The Gleason score is used by pathologists to grade prostate cancers.
If the cancer cells and their growth patterns look very abnormal, a grade 5 is assigned. The Gleason score is the sum of the two most prevalent patterns.
These 2 grades are added to yield the Gleason score.
The highest Gleason score therefore is 10.
For example, if the Gleason score is written as 3+4=7, it means that most of the tumor is grade 3 and the second most common or most malignant grade is 4.
Tumor in the Transition zone is determined primarily from>
T2. (T for T)
Peripheral zone is determined primarily from
DWI
PZ-DWI = Linear/Wedge
PI-RADS 2
PZ-DWI = Vague Patchy
PI-RADS 3
PZ-DWI = Focal < 1.5 cm
PI-RADS 4
PZ-DWI = Vague Patchy + Enhancment
PI-RADS 4
TZ-T2 = Atypical Nodule - no capsule
PI-RADS 2
PZ-DWI = Focal > 1.5 cm or with extracapsular extension
PI-RADS 5
TZ-T2 = Atypical Nodule - no capsule + Focal Restricted DWI
PI-RADS 3
TZ-T2 = Heterogeneous, blurry margins
PI-RADS 3
TZ-T2 = Heterogeneous, blurry margins + Restricted DWI < 1.5
PI-RADS 4
TZ-T2 = Low Signal < 1.5 cm)
PI-RADS 4
TZ-T2 = Low Signal > 1.5 or with extracapsular extension
PI-RADS 5
Benign Prostatic Hyperplasaia (BPH) commonly invovles what zone?
Transitional Zone (Cancer is rare in transitional zone - 10%)
What hyperterophies in BPH and sticks up to the bladder?
Median Lobe
Benign Prostatic Hyperplasia
“J shaped”, “Fishhook”, or “Hockey stick” shaped ureter - as the distal ureter curves around the enlarged prostate
Benign prostatic Hyperplasia
Benign prostatic Hyperplasia
In the Transitional Zone (Central Gland)
T2 Heterogenous
Can Restrict Diffusion
May enhance and washout
PZ + Dark T2 + Dark ADC (Restricted Diffusion) + Early enhancment and early washout =
Peripheral zone tumor
PZ + Dark D2/Bright T1 + Dark ADC (Resticted diffusion) =
Peripheral zone hemorrhage
TZ + Dark “Charcoal” T2 + Dark ADC + Early enhancement and early washout =
Central gland / Transition zone Tumor
TZ + Dark “Well-defined” T2 + Less darck ADC + Can enhance =
BPH
