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Introduction Magnetic resonance imaging (MRI) is one of the most useful imaging methods for the non-invasive evaluation of prostate cancer. The prostate and periprostatic structures can be depicted with excellent soft-tissue resolution with MRI, allowing assessment of the local extent of disease. Currently, the role of MRI in prostate cancer is evolving to improve disease detection and staging, to determine the aggressiveness of disease, and to optimize individualized treatment planning and follow-up. This article reviews the role of MRI in the diagnosis and management of prostate cancer, from diagnosis to post-treatment follow-up. Specific imaging features of prostate cancer as seen on MR imaging are described, and the advantages, limitations, and clinically relevant uses of various MRI techniques are discussed. Magnetic resonance imaging techniques A magnetic field strength of at least 1.5 Tesla (T) is required for a high-quality MRI study of the prostate. A magnetic field strength of 3 T provides a greater signal-to-noise ratio that allows higher resolution imaging. The advantages of higher resolution imaging are the detection of small tumors and more accurate local staging. The use of an endorectal coil with a pelvic phased-array coil markedly improves image quality and is recommended. Magnetic resonance imaging parameters applied in prostate imaging depend on the type of MRI system used and the field strength. In general, T 1 -weighted transverse images of the entire pelvis are obtained for the assessment of post-biopsy hemorrhage in the prostate, pelvic lymph nodes, and bones.

Radiation therapy has played a significant role in the management of prostate cancer for over half a century. High-energy megavoltage linear accelerators developed in the 1950s provided deeper penetration of tumoricidal dose, superficial tissue sparing and hence lower morbidity profiles than earlier models. The introduction of the CT scanner and complex computer-based treatment planning software in the 1980s improved three-dimensional target localization and enhanced accuracy. Subsequently, intensity-modulated treatment planning capabilities enabled highly conformal dose escalation for improved outcomes without added toxicity. New image-guidance techniques have further refined treatment delivery by compensating for internal organ variability. Concurrent with vast improvements in external beam radiation therapy, modern brachytherapy methods, facilitated by dynamic imaging, have become sophisticated and popular techniques for primary as well as salvage therapies. In addition, refinement of prognostic factors, particularly prostate-specific antigen (PSA), and contemporary imaging for staging have substantially improved patient selection for individualized therapy.

Introduction Over 186 000 men will be diagnosed with prostate cancer in 2008, accounting for approximately 25% of newly diagnosed cancers in the US male population [1]. In the era of prostate-specific antigen (PSA) screening, prostate cancer has undergone a significant downward stage and risk migration, with an increasing proportion of low-risk, organ-confined disease being diagnosed [2]. Transrectal ultrasound (TRUS) imaging of the prostate has played a fundamental role in the diagnosis, staging, and management of prostate cancer. During the past decade, technological innovations have improved the detection of prostate cancer. Clinical research continues to focus on methods to accurately and efficiently identify clinically significant neoplasms. In this chapter, we describe contemporary techniques for TRUS imaging and detection of prostate cancer. Sonographic anatomy Accurate evaluation and assessment of the prostate during TRUS requires a fundamental understanding of the underlying sonographic anatomy and histopathology of the gland. The prostate gland is anatomically divided into zones, originally described by McNeal in 1981 [3]. Zonal architecture of the prostate is defined anatomically with respect to glandular drainage into the prostatic urethra, and consists of a total of four glandular zones – the periurethral zone, the transition zone, the central zone, and the peripheral zone – as well as the anterior fibromuscular stroma. The anterior fibromuscular stroma does not contain any glands, whereas the peripheral zone comprises approximately 70% of the glandular tissue in the normal prostate.