For radiologists, no professional meeting is more exciting than the annual Radiological Society of North America (RSNA) meeting. Don’t let “North America” mislead you. This Chicago-based event opens on the Sunday after Thanksgiving and runs for six days. As the largest global medical conference, it draws tens of thousands of attendees from all over the world. In addition to radiologists, it includes medical physicists and other medical professionals as well as radiologists. The exhibit floor boasts breakthrough technologies from major corporations (Siemens, GE, Philips, etc.) to small companies selling accessory products.
The hard copy of the agenda lists the plenary sessions, courses, papers, and posters. It is the size of a medium phone book—and just as heavy. In addition to scheduled live presentations, the Education Hall holds hundreds of poster presentations that were accepted for the conference. Although I was unable to attend all six days, the time I spent there was productive and educational.
I want to share a poster from Ottawa Hospital[i] that had great information on multiparametric (mp) MRI used to image the anterior of the prostate gland. The prostate is divided into four zones: peripheral, central, transitional and anterior. Anterior means “in front” and it’s the portion of the gland in front of the urethra. It actually does not contain glandular tissue, but is made up of what’s called fibromuscular stroma. Standard 12-core TRUS biopsies commonly miss prostate cancer in the anterior, and a digital rectal exam cannot access the surface of the gland.
According to the poster, anterior prostate cancer is defined as a tumor in which more than 75% of malignant tissue is anterior to the urethra. About 25-30% of PCa is located anteriorly. Up to 35% of these cancers are intermediate to high grade. Because they are often missed when they are in early stages, by the time they are detected they are typically larger, and more likely to have positive surgical margins if treated with prostatectomy. The importance of this poster lies in the fact that it contained images showing how successfully mpMRI overcomes the diagnostic limitations of the DRE and TRUS biopsy.
The images depicted mpMRI’s ability to distinguish healthy tissue from BPH (benign prostatic hypertrophy) and prostate cancer in the gland anterior. The take-home message is the value of mpMRI to identify suspicious anterior lesions, and to plan and guide targeted biopsy needles directly into this area.
I’ll report on one or two more posters in the coming blog entries.
[i] Moosavi B, Flood TA, Schieda N. A users guide to the “anterior” prostate gland: multi-parametric (mp) MRI-pathologic correlation. Poster URE002-b. RSNA 2014 (Chicago).