Prostate cancer is a prevailing health concern in men, being the second most common cancer in men worldwide. In the United States alone, approximately 1 in 8 men will be diagnosed with this disease during their lifetime. The risk of developing prostate cancer rises with age, with over 60% of cases diagnosed in men aged 65 or older. Early detection remains important in enhancing the chances of successful treatment and management. Advancements in 3D imaging support the assessment of the disease as well as enable precision biopsy.
What is Prostate Cancer?
Prostate cancer occurs when there’s an uncontrolled growth of cells in the prostate, a gland in the male reproductive system located below the bladder. While the exact cause is still being researched, certain factors such as age and the presence of prostate-specific antigen (PSA) in the blood may increase the risk. PSA is a protein produced by both cancerous and non-cancerous tissues in the prostate. A high level of PSA may indicate prostate cancer or other conditions. Early diagnosis and treatment are crucial, as timely intervention can improve outcomes and survival rates.
Figure A (Right): Example of an axial MR slice with the prostate contour labeled in yellow, and the lesion contour labeled in blue.
The Role of 3D Imaging in Prostate Cancer Detection
When a man has persistently elevated PSA levels or abnormalities are found during a Digital Rectal Exam (DRE), an MRI scan of the prostate is often recommended for further assessment and diagnosis. The 3DQ Lab uses this scan to create images, perform measurements, and help prepare for biopsy.
The 3DQ Lab employs artificial intelligence (AI) to outline the prostate on the MRI scan, which technologists refine if needed. Should any lesions be found present, a radiologist will identify their number and boundaries. The Prostate Imaging-Reporting and Data System (PI-RADS) scale, which ranges from 1 to 5, assesses the likelihood of an MRI finding being indicative of significant prostate cancer, with 1 being very low and 5 being very high probability. Based on the PI-RADS score and other factors, the patient might then be suggested for a biopsy. This information is compiled into a report that is accessible by the urology and oncology teams.
Figure B (Left): Example PI-RADS report.
The Role of 3D Imaging in Prostate Biopsy
The 3DQ Lab enhances the accuracy of lesion location for biopsies by providing detailed 3D images like axial images with contours. A urologist overlays the contoured images on a live ultrasound, which is then used for multiple biopsy cores. . During this procedure, a thin needle is guided by the fused ultrasound and 3DQ Lab contours to obtain tissue samples from the prostate gland, which are then microscopically examined for cancer cells.
Figure C (Right): 3D visual reconstruction of the prostate and lesion with imaging planes displaying the MRI data.
Biopsy results indicate the next steps needed for prostate cancer management. If the biopsy reveals cancer cells, the aggressiveness of the cancer is assessed using the Gleason score, which ranges from 6 (less aggressive) to 10 (very aggressive.) This score, combined with other data like PSA levels and the extent of cancer within the biopsy samples, helps categorize the patient’s risk level as low, intermediate, or high.
Next steps include:
- Active Surveillance: For low-risk cancers, rather than immediate treatment, the patient’s condition is monitored closely with regular PSA tests, MRIs, and sometimes repeat biopsies.
- Treatment: For intermediate and high-risk cancers, or if low-risk cancer becomes more aggressive, treatments may be initiated. Options include surgery (prostatectomy), radiation therapy, hormone therapy, chemotherapy, immunotherapy, or a combination.
- Follow-up: Post-treatment, regular check-ups are essential to monitor for cancer recurrence, manage side effects, and ensure the patient’s well-being.
In the event the biopsy does not detect cancer, but the clinical suspicion remains high due to factors like continually rising PSA, a repeat biopsy or other tests might be recommended.