Diagnostic Ultrasound - Abdomen and Pelvis

Prostatic Carcinoma
Diagnoses: Urinary Tract
IMAGING
• Location of prostate cancer: Peripheral zone (PZ) 70-80%,
transition zone (TZ) 20%, central zone (CZ) 1-5%
• Transrectal ultrasound (TRUS) is imaging of choice to guide
biopsy in evaluation for PCa but performs poorly in cancer
detection and staging
• Calculate prostate volume using largest cross-sectional
image in transverse and mid sagittal planes: Transverse x AP
x long x 0.52
• MR is most sensitive imaging technique for PCa diagnosis
and staging
○ PZ: T2 dark lesion with restricted diffusion; TZ: "Erased
charcoal" sign on T2WI
• Targeted MR-guided and MR/ultrasound fusion-guided
biopsy is promising for increasing detection of high-risk
prostate cancer while reducing detection of low-risk cancer
compared with standard biopsy
KEY FACTS
PATHOLOGY
• Most common noncutaneous malignancy in western world,
2nd most common cause of cancer deaths among men
• 95% of tumors are acinar adenocarcinoma
• Staging based on TNM, PSA at time of diagnosis, and
Gleason score
CLINICAL ISSUES
• Management is complex due to difficulty in accurate
staging and in predicting speed of disease progression
• Despite having higher volumes and PSA values at diagnosis,
TZ cancers are less likely to be associated with seminal
vesicle, extraprostatic and lymphovascular invasion
DIAGNOSTIC CHECKLIST
• Classic description of hypoechoic prostate lesion for PCa is
less valuable in PSA era when cancer is diagnosed earlier;
greater than 30-40% PCa are invisible on TRUS
Longitudinal graphic shows advanced prostatic carcinoma (PCa) with extracapsular spread to the adjacent pelvic structures such as the
bladder ſt, rectal wall , and symphysis pubis .
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