Imaging the Prostate: The Roles of Sonography, CT, MRI, and PET

George Tsoukatos, BPS, RT (R)

^*Medical Imaging Consultant, Radiology Support Services, Germantown, NY

Address correspondence to: George Tsoukatos, BPS, RT(R), Radiology Support Services, PO Box 215, Germantown, NY 12526. Email: radiologytechnique@gmail.com.

Disclosure statement: The author reports having no significant financial or advisory relationships with corporate organizations related to this activity.

ABSTRACT

Prostate cancer (PCa) is the second-most common type of cancer diagnosed in men worldwide, with about 1 in 9 men being diagnosed with PCa in their lifetime. Men with PCa often experience no symptoms in its early stages, and diagnostic techniques are either invasive, resource intensive, or have low efficacy, making widespread early detection very difficult. Recently, multimodality radiologic imaging has become extremely important in diagnosing and staging, as well as post-treatment evaluation and detecting recurrences of PCa. Typically, only 2 diagnoses, benign prostatic hyperplasia and PCa, cover more than 95% of cases of PCa disease. Current diagnostic tools and treatment goals are focused on identifying and treating patients with adverse high-risk tumors, while minimizing overtreating those with low-risk tumors. The most common method for detecting PCa is a systematic sonography-guided prostate biopsy in those with elevated prostate-specific antigen levels and/or positive findings on a digital rectal examination. However, using only these methods can sometimes fail to diagnose all patients. As a result, multiple modalities and/or testing strategies are often employed. Transrectal ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are also used for early detection and recurrence of PCa, as well as for detecting distant metastases. Nuclear imaging-based positron emission tomography (PET)-CT is also a rapidly developing technique that helps compensate for the limitations of whole-body evaluation and precise prognosis prediction. As PCa and other diseases and conditions of the prostate can be difficult to detect, it's imperative that radiologic technicians (RTs) of all modalities be well versed in the best strategies for conducting common tests and imaging studies and how they should be employed. This course will provide an overview of imaging modalities currently used for diagnosing men with PCa, and other diseases of the prostate, including sonography, MRI, CT, and PET-CT, along with step-by-step procedures, safety considerations, and patient preparations for each. It will also outline the value of these modalities in distinct clinical scenarios, ranging from initial diagnosis to biopsy guidance techniques, treatment monitoring, and detection of metastasis. A detailed overview of the anatomy of the prostate, tumor staging and grading scales, and examples of various diseases of the prostate and how they appear on screen will also be provided.