Role of Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy and Transrectal Ultrasound in Evaluation of Prostatic Pathologies with Focus on Prostate Cancer

Background: Prostate cancer (PC) is an important medical and socio-economical problem due to its increasing incidence. The development of the prostate specific antigen (PSA) test, and a continuing decrease in the rates of other common neoplasms, such as lung and stomach since mid-1980s, prostate cancer has become one of the most common cancers among men. Prostate cancer (PC) is the second most common cancer in men, preceded only by lung cancer, and its early diagnosis is crucial for a successful treatment, that will prolong survival and improve quality of life. The main objective of our study was to evaluate the role of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and transrectal ultrasound (TRUS) in detecting prostatic pathologies and staging of prostate cancer by correlating these methods with histopathological results.

Material/Methods: The study is a cross-sectional diagnostic study performed in 66 patients with a high degree of clinical suspicion of prostatic pathology. All patients underwent TRUS, T1W, T2W, DWI, and 3D PRESSMRS sequences, and we also calculated ADC values and Cho Cr/Cit MRS ratios for all patients.

Results: Combination of MRI and MRS showed the highest diagnostic accuracy among the imaging modalities in detecting of prostatic neoplasm, followed by MRI, and then by TRUS. MRS plays a complementary role to MRI, by increasing its diagnostic accuracy. Due to a high cost, limited availability and increased scanning time, combination of MRI and MRS is currently not recommended as a first line investigation for detecting prostate neoplasms, hence USG (TRUS) remains the first line investigation due to its low cost, easy availability, time effectiveness and comparable efficacy.

Conclusions: MRI MRS has more diagnostic accuracy than MRI alone for detection of prostate pathologies. MRS, plays significant complementary role and should be included in the routine MR imaging protocols. MRI helps in diagnosis, localization, better tissue characterization and staging of prostate cancer. TRUS is easily available, cost effective and has comparable efficacy.