Prostate Cancer Detection in Patients With Total Serum Prostate-Specific Antigen Levels of 4-10 ng/mL: Diagnostic Efficacy of Diffusion-Weighted Imaging, Dynamic Contrast-Enhanced MRI, and T2-Weighted Imaging

• Published in: American journal of roentgenology (1976) Vol. 197; no. 3; pp. 664 - 670
• Main Authors: TAMADA, Tsutomu, SONE, Teruki, HIGASHI, Hiroki, JO, Yoshimasa, YAMAMOTO, Akira, KANKI, Akihiko, ITO, Katsuyoshi
• Format: Journal Article
• Language: English
• Published: Reston, VA American Roentgen Ray Society 01.09.2011
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Contrast Media; Diffusion Magnetic Resonance Imaging; Gadolinium DTPA; Gynecology. Andrology. Obstetrics; Humans; Magnetic Resonance Imaging - methods; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Retrospective Studies; Sensitivity and Specificity; Statistics, Nonparametric; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Human; Prostate tumor; Urinary system disease; cancer screening; Prostate disease; early diagnosis of cancer; MRI; Malignant tumor; Medical screening; Nuclear magnetic resonance imaging; prostatic neoplasms; Medical imagery; Diagnosis; Urogenital system; Male genital diseases; Prostate cancer; Prostate; Cancer; prostate-specific antigen
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.10.5923

The purpose of this study is to evaluate the utility of T2-weighted imaging, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI) for detecting prostate cancer in patients with total serum prostate-specific antigen (PSA) levels of 4-10 ng/mL, which is referred to as the "gray zone." Fifty patients with gray-zone PSA levels underwent MRI before biopsy. According to the sites of biopsy, the prostate was divided into eight regions on MRI scans. These regions were evaluated individually for the following features: detectability of prostate cancer on per-region and per-patient bases, and relationship between tumor size and positive or negative MRI findings for tumor detection. On a per-region basis, the sensitivity and specificity of tumor detection were 36% and 97% for T2-weighted imaging, 43% and 95% for DCE-MRI, 38% and 96% for DWI, and 53% and 93% for the combined method of MRI, respectively. The sensitivity of combined MRI to detect tumor was significantly higher than those of the individual methods (p < 0.001 to p = 0.001). Tumor size was significantly larger in regions with positive MRI findings than in regions with negative MRI findings (p = 0.004). On a per-patient basis, sensitivity and specificity of combined MRI to detect prostate cancer were 83% and 80%, respectively. Combined T2-weighted imaging, DWI, and DCE-MRI findings appear to be potentially useful for detecting and managing prostate cancer, even when performed for patients with gray-zone PSA levels.