Cases
The following two cases demonstrate two examples of men who had
low-intermediate risk one-sided prostate cancer on their TRUS biopsies
and then went onto have multi-sequence MRI followed by template biopsies.
They demonstrate the accuracy of both techniques in detecting cancer which
the original biopsies missed or undergraded.
Case 1
A man in his 60s with PSA 8, Gleason 3+3, one-sided disease had an MRI-scan which showed disease on both sides. However, it was difficult to know what risk disease each side had. Template biopsies confirmed where the disease was and what Gleason score each area had.
A dynamic contrast enhanced MRI showing two tumour foci. One in the lower right side and one in the upper left side.
Template biopsies taken on the same patient. The letter denote where the biopsies were taken. The blue shading indicates positive biopsies, correlating with the areas on MRI.
A man in his 60s with PSA 8, Gleason 3+3, one-sided disease had an MRI-scan which showed disease on both sides. However, it was difficult to know what risk disease each side had. Template biopsies confirmed where the disease was and what Gleason score each area had.
A dynamic contrast enhanced MRI showing two tumour foci. One in the lower right side and one in the upper left side.
Template biopsies taken on the same patient. The letter denote where the biopsies were taken. The blue shading indicates positive biopsies, correlating with the areas on MRI.
Case 2
A man in his 50s with PSA 5, Gleason 3+3, one-sided disease had an MRI-scan which showed one-sided disease, but it was only after the prostate mapping biopsies were carried that he was found to have medium risk Gleason 3+4 disease which was on both sides of the prostate.
Normal MRI prior to biopsy (T2-weighted) showing no obvious tumour.
Dynamic contrast enhanced MRI demonstrating a tumour in the left side of the gland (dotted lines).
Diffusion weighted scan demonstrating a tumour in the left side of the prostate (dotted lines)
A man in his 50s with PSA 5, Gleason 3+3, one-sided disease had an MRI-scan which showed one-sided disease, but it was only after the prostate mapping biopsies were carried that he was found to have medium risk Gleason 3+4 disease which was on both sides of the prostate.
Normal MRI prior to biopsy (T2-weighted) showing no obvious tumour.
Dynamic contrast enhanced MRI demonstrating a tumour in the left side of the gland (dotted lines).
Diffusion weighted scan demonstrating a tumour in the left side of the prostate (dotted lines)
Template biopsies. This confirms the tumour in the left side of the gland (red boxes), but has also demonstrated a tumour in the right side (blue boxes) that MRI did not detect.
A biopsy has been taken approximately for each small white dot - a
coordinate - which are spaced every 5mm. Each coordinate is designated a letter and a
number representing the 'x' and 'y' coordinates. So, in this example, cancer has been
found at coordinates D1.5, d1.5, E1.5, e1.5, D2.0, d2.0, E2.0, D2.5 and a separate focus
in coordinates C2.5, C3.0, c3.0."