MR Imaging of Prostate Cancer in Radiation Oncology: What Radiologists Need to Know

Published Online:https://doi.org/10.1148/rg.333125041

An overview of radiation therapy techniques for prostate cancer is presented, and the roles and limitations of multiparametric MR imaging in treatment planning for radiation therapy of prostate cancer are discussed.

Radiation therapy (RT) is one of the principal treatment modalities for localized or locally advanced prostate cancer. The two major forms of RT for prostate cancer are external-beam RT (EBRT) with a photon or proton beam and brachytherapy. With modern conformal techniques for EBRT (three-dimensional conformal RT, intensity-modulated RT, and image-guided RT) and advanced computer-based planning systems for brachytherapy, the dose can be more precisely delivered to the prostate while reducing unnecessary radiation to normal tissue. The dominant intraprostatic tumor can be targeted with a higher dose, so-called dose painting. Magnetic resonance (MR) imaging plays a pivotal role in pretreatment assessment of prostate cancer. Multiparametric MR imaging, a combination of anatomic and functional MR imaging techniques (diffusion-weighted imaging, dynamic contrast material–enhanced imaging, and MR spectroscopy), significantly improves the accuracy of tumor localization and local staging. For pretreatment planning, anatomic MR imaging provides highly accurate local staging information, particularly about extraprostatic extension and seminal vesicle invasion. The dominant intraprostatic tumor and local recurrence in the prostatectomy bed can be better localized with multiparametric MR imaging for dose painting. MR imaging allows excellent delineation of the contours of the prostate and surrounding structures. It can also be used in early posttreatment evaluation after brachytherapy.

References

  • 1 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62(1):10–29.
  • 2 Howlader N, Noone AM, Krapcho M, et al.. SEER cancer statistics review, 1975-2008. Bethesda, Md: National Cancer Institute, 2011.
  • 3 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Prostate. In: AJCC cancer staging handbook. 7th ed. New York, NY: Springer, 2010; 525–538.
  • 4 National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: prostate cancer. Fort Washington, Pa: National Comprehensive Cancer Network, 2012.
  • 5 D’Amico AV, Whittington R, Kaplan I, et al.. Equivalent biochemical failure-free survival after external beam radiation therapy or radical prostatectomy in patients with a pretreatment prostate specific antigen of > 4-20 ng/ml. Int J Radiat Oncol Biol Phys 1997;37(5):1053–1058.
  • 6 Kupelian P, Katcher J, Levin H, et al.. External beam radiotherapy versus radical prostatectomy for clinical stage T1-2 prostate cancer: therapeutic implications of stratification by pretreatment PSA levels and biopsy Gleason scores. Cancer J Sci Am 1997;3(2):78–87.
  • 7 Zelefsky MJ, Wallner KE, Ling CC, et al.. Comparison of the 5-year outcome and morbidity of three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic cancer. J Clin Oncol 1999;17(2):517–522.
  • 8 Kuban DA, Tucker SL, Dong L, et al.. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008;70(1):67–74.
  • 9 Peeters ST, Heemsbergen WD, Koper PC, et al.. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 2006;24(13):1990–1996.
  • 10 Cellini N, Morganti AG, Mattiucci GC, et al.. Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: implications for conformal therapy planning. Int J Radiat Oncol Biol Phys 2002;53(3):595–599.
  • 11 Pucar D, Sella T, Schöder H. The role of imaging in the detection of prostate cancer local recurrence after radiation therapy and surgery. Curr Opin Urol 2008;18(1):87–97.
  • 12 Pickett B, Vigneault E, Kurhanewicz J, Verhey L, Roach M. Static field intensity modulation to treat a dominant intra-prostatic lesion to 90 Gy compared to seven field 3-dimensional radiotherapy. Int J Radiat Oncol Biol Phys 1999;44(4):921–929.
  • 13 De Meerleer G, Villeirs G, Bral S, et al.. The magnetic resonance detected intraprostatic lesion in prostate cancer: planning and delivery of intensity-modulated radiotherapy. Radiother Oncol 2005;75(3):325–333.
  • 14 van Lin EN, Fütterer JJ, Heijmink SW, et al.. IMRT boost dose planning on dominant intraprostatic lesions: gold marker-based three-dimensional fusion of CT with dynamic contrast-enhanced and 1H-spectroscopic MRI. Int J Radiat Oncol Biol Phys 2006;65(1):291–303.
  • 15 Haider MA, van der Kwast TH, Tanguay J, et al.. Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol 2007;189(2):323–328.
  • 16 Delongchamps NB, Rouanne M, Flam T, et al.. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int 2011;107(9):1411–1418.
  • 17 Chen M, Dang HD, Wang JY, et al.. Prostate cancer detection: comparison of T2-weighted imaging, diffusion-weighted imaging, proton magnetic resonance spectroscopic imaging, and the three techniques combined. Acta Radiol 2008;49(5):602–610.
  • 18 Fütterer JJ, Heijmink SW, Scheenen TW, et al.. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology 2006;241(2):449–458.
  • 19 Tanimoto A, Nakashima J, Kohno H, Shinmoto H, Kuribayashi S. Prostate cancer screening: the clinical value of diffusion-weighted imaging and dynamic MR imaging in combination with T2-weighted imaging. J Magn Reson Imaging 2007;25(1):146–152.
  • 20 Boonsirikamchai P, Kaur H, Kuban DA, Jackson E, Hou P, Choi H. Use of maximum slope images generated from dynamic contrast-enhanced MRI to detect locally recurrent prostate carcinoma after prostatectomy: a practical approach. AJR Am J Roentgenol 2012;198(3):W228–W236.
  • 21 Kundra V, Silverman PM, Matin SF, Choi H. Imaging in oncology from the University of Texas M. D. Anderson Cancer Center: diagnosis, staging, and surveillance of prostate cancer. AJR Am J Roentgenol 2007;189(4):830–844.
  • 22 Mirilas P, Skandalakis JE. Urogenital diaphragm: an erroneous concept casting its shadow over the sphincter urethrae and deep perineal space. J Am Coll Surg 2004;198(2):279–290.
  • 23 Coakley FV, Hricak H, Wefer AE, Speight JL, Kurhanewicz J, Roach M. Brachytherapy for prostate cancer: endorectal MR imaging of local treatment-related changes. Radiology 2001;219(3): 817–821.
  • 24 Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging prostate cancer: a multidisciplinary perspective. Radiology 2007;243(1):28–53.
  • 25 Fütterer JJ, Scheenen TW, Heijmink SW, et al.. Standardized threshold approach using three-dimensional proton magnetic resonance spectroscopic imaging in prostate cancer localization of the entire prostate. Invest Radiol 2007;42(2):116–122.
  • 26 Yuen JS, Thng CH, Tan PH, et al.. Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy. J Urol 2004; 171(4):1482–1486.
  • 27 Sala E, Akin O, Moskowitz CS, et al.. Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. Radiology 2006;238(3):929–937.
  • 28 Sato C, Naganawa S, Nakamura T, et al.. Differentiation of noncancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate. J Magn Reson Imaging 2005;21(3):258–262.
  • 29 Hosseinzadeh K, Schwarz SD. Endorectal diffusion-weighted imaging in prostate cancer to differentiate malignant and benign peripheral zone tissue. J Magn Reson Imaging 2004;20(4):654–661.
  • 30 Jackson MW, Bentel JM, Tilley WD. Vascular endothelial growth factor (VEGF) expression in prostate cancer and benign prostatic hyperplasia. J Urol 1997;157(6):2323–2328.
  • 31 Alonzi R, Padhani AR, Allen C. Dynamic contrast enhanced MRI in prostate cancer. Eur J Radiol 2007;63(3):335–350.
  • 32 Bonekamp D, Jacobs MA, El-Khouli R, Stoianovici D, Macura KJ. Advancements in MR imaging of the prostate: from diagnosis to interventions. RadioGraphics 2011;31(3):677–703.
  • 33 van Dorsten FA, van der Graaf M, Engelbrecht MR, et al.. Combined quantitative dynamic contrast-enhanced MR imaging and (1)H MR spectroscopic imaging of human prostate cancer. J Magn Reson Imaging 2004;20(2):279–287.
  • 34 Zakian KL, Eberhardt S, Hricak H, et al.. Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging—initial results. Radiology 2003;229(1):241–247.
  • 35 Westphalen AC, Coakley FV, Kurhanewicz J, Reed G, Wang ZJ, Simko JP. Mucinous adenocarcinoma of the prostate: MRI and MR spectroscopy features. AJR Am J Roentgenol 2009;193(3):W238–W243.
  • 36 Barrett A, Dobbs J, Morris S, Roques T. Prostate. In: Practical radiation therapy planning. 4th ed. London, England: Hodder Arnold, 2009; 332–350.
  • 37 Schallenkamp JM, Herman MG, Kruse JJ, Pisansky TM. Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys 2005;63(3):800–811.
  • 38 Kupelian PA, Willoughby TR, Meeks SL, et al.. Intraprostatic fiducials for localization of the prostate gland: monitoring intermarker distances during radiation therapy to test for marker stability. Int J Radiat Oncol Biol Phys 2005;62(5):1291–1296.
  • 39 Chung PW, Haycocks T, Brown T, et al.. On-line aSi portal imaging of implanted fiducial markers for the reduction of interfraction error during conformal radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 2004;60(1):329–334.
  • 40 Kotte AN, Hofman P, Lagendijk JJ, van Vulpen M, van der Heide UA. Intrafraction motion of the prostate during external-beam radiation therapy: analysis of 427 patients with implanted fiducial markers. Int J Radiat Oncol Biol Phys 2007;69(2):419–425.
  • 41 Kagan AR, Schulz RJ. Proton-beam therapy for prostate cancer. Cancer J 2010;16(5):405–409.
  • 42 Nag S, Beyer D, Friedland J, Grimm P, Nath R. American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 1999;44(4):789–799.
  • 43 Sanda MG, Dunn RL, Michalski J, et al.. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008;358(12): 1250–1261.
  • 44 Ohori M, Abbas F, Wheeler TM, Kattan MW, Scardino PT, Lerner SP. Pathological features and prognostic significance of prostate cancer in the apical section determined by whole mount histology. J Urol 1999;161(2):500–504.
  • 45 Ling CC, Humm J, Larson S, et al.. Towards multidimensional radiotherapy (MD-CRT): biological imaging and biological conformality. Int J Radiat Oncol Biol Phys 2000;47(3):551–560.
  • 46 Heijmink SW, Scheenen TW, van Lin EN, et al.. Changes in prostate shape and volume and their implications for radiotherapy after introduction of endorectal balloon as determined by MRI at 3T. Int J Radiat Oncol Biol Phys 2009;73(5):1446–1453.
  • 47 Mizowaki T, Cohen GN, Fung AY, Zaider M. Towards integrating functional imaging in the treatment of prostate cancer with radiation: the registration of the MR spectroscopy imaging to ultrasound/CT images and its implementation in treatment planning. Int J Radiat Oncol Biol Phys 2002;54(5): 1558–1564.
  • 48 Pouliot J, Kim Y, Lessard E, Hsu IC, Vigneron DB, Kurhanewicz J. Inverse planning for HDR prostate brachytherapy used to boost dominant intraprostatic lesions defined by magnetic resonance spectroscopy imaging. Int J Radiat Oncol Biol Phys 2004;59(4): 1196–1207.
  • 49 Zelefsky MJ, Valicenti RK, Hunt M, et al.. Low-risk prostate cancer. In: Perez and Brandy’s principles and practice of radiation oncology. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2008; 1339–1483.
  • 50 Frank SJ, Stafford RJ, Bankson JA, et al.. A novel MRI marker for prostate brachytherapy. Int J Radiat Oncol Biol Phys 2008;71(1):5–8.
  • 51 Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999;281(17):1591–1597.
  • 52 Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy: the 15-year Johns Hopkins experience. Urol Clin North Am 2001;28(3):555–565.

Article History

Received: Mar 22 2012
Revision requested: Apr 18 2013
Revision received: Jan 14 2013
Accepted: Jan 15 2013
Published online: May 3 2013
Published in print: May 2013