WellSpan York Hospital, based in York, Pennsylvania, USA, is an advanced specialty care hospital. According to Dr. Steiner, the Chairman of Imaging, the hospital has been using multiparametric MRI and fused MRI/ultrasound image-guided biopsies in prostate cancer diagnosis since mid-2019. He has built a referral base within the five-county community surrounding York and northern Maryland regions.
“Contrary to other techniques, MRI allows for examination of the entire prostate gland with high soft-tissue contrast. Multiparametric MRI allows us to identify suspicious lesions and give these a PI-RADS score . For high-risk lesions, a biopsy can then be performed, guided by MRI images that are fused with ultrasound images in real time. This allows targeting of the lesions that were identified before.”
Dr. Steiner explains that techniques for prostate imaging and cancer diagnosis have not changed substantially in the past 30 years, despite the known limitations. PSA testing alone is usually insufficient and current TRUS biopsy techniques often miss anywhere from 40 to 50% of the gland . “PSA testing is imprecise and has a significant number of false positive as well as false negative tests,” he says. “It is, however, the accepted first path of entry for most patients that are ultimately diagnosed with prostate carcinoma.”
The use of MRI has significantly improved capabilities in prostate cancer diagnosis, according to Dr. Steiner. “Multiparametric prostate MRI allows us to look at three parameters to build our diagnosis on: conventional T1 and T2 signal intensity, diffusionweighted imaging and ADC map, as well as dynamic flow imaging, to define the highest probability of prostate carcinoma.”
The standard PI-RADS system is then used to grade lesions based on the MRI findings. For PI-RADS 1 and 2, clinically significant cancer is (highly) unlikely. Intermediate PI-RADS 3 lesions represent a kind of diagnostic “grey area” – these lesions may become PI-RADS 4 lesions if they demonstrate a fusion restriction and hypervascular tumor flow pattern or depending upon index of suspicion. PI-RADS 4 and 5 lesions have a statistically high chance of being a clinically significant prostate carcinoma and should be biopsied. Once biopsy is performed, the pathologists characterize the biopsy samples with either a Gleason score or an ISUP grade group .
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