Preliminary Diagnosis: Prostate Cancer
I. What imaging technique is first-line for this diagnosis?
Prostatic ultrasound.
II. Describe the advantages and disadvantages of this technique for diagnosing prostate cancer.
Advantages
- Moderately sensitive and specific in detecting, detailing, and characterizing prostate abnormalities, such as cancer.
- May help guide biopsy.
- Highly specific in characterizing the vascularity of a neoplastic process.
- Does not expose patients to ionizing radiation.
Disadvantages
- Less adept in detailing the extent of soft tissue infiltration and extension.
- Highly operator dependent.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
- MRI with IV contrast.
- CT imaging with IV contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing prostate cancer.
MRI with IV contrast
Advantages
- Gold standard in detecting, detailing, and characterizing prostate neoplasm and extension of neoplasm.
- Does not expose patients to ionizing radiation.
- Offers exquisite detail of the surrounding soft tissues and the zones of the prostate gland (central, peripheral, and transitional zone).
- Contrasted MR imaging helps evaluate for any secondary complications.
Disadvantages
- May be subject to motion and susceptibility weighted artifact, degrading image quality.
- Less sensitive and specific for detailing the osseous structures.
- Expensive.
- Time consuming.
CT imaging with IV contrast
Advantages
- Quick and relatively inexpensive imaging modality as compared to MR imaging.
- May help guide percutaneous biopsy and treatment.
- Moderately sensitive and specific in characterizing the surrounding soft tissues and extension of tumors.
- Highly sensitive and specific in characterizing the surrounding osseous and mineralized structures.
Disadvantages
- Exposes patients to ionizing radiation.
- Contrasted CT imaging helps evaluate for any secondary complications.
VI. What are the contraindications for the alternative imaging techniques?
MRI with IV contrast
May be contraindicated in patients with non-MR compatible hardware.
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CT imaging with IV contrast
May be contraindicated in patients who are pregnant.
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