Matthew D. Rifkin

ENDO-RECTAL COIL MAGNETIC RESONANCE IMAGING IN CLINICALLY LOCALIZED PROSTATE CANCER: IS IT ACCURATE?

PURPOSEnWe assessed the staging accuracy of endo-rectal coil magnetic resonance imaging (MRI) in patients with clinically localized prostate cancer.nnnMATERIALS AND METHODSnIn a prospective study 56 consecutive patients underwent endo-rectal coil MRI before scheduled surgery. The ability of MRI to identify tumor involvement of the periprostatic soft tissue, seminal vesicles and pelvic lymph nodes was assessed by comparison with final pathological stage.nnnRESULTSnSpecificity of MRI was relatively high (84% for periprostatic soft tissue, 93% for seminal vesicles and 91% for pelvic lymph nodes) and sensitivity was low (22, 23 and 0%, respectively). Accuracy was 64% for identification of periprostatic soft tissue invasion, 77% for seminal vesicle invasion and 86% for pelvic lymph node metastases. Had we excluded from surgery patients with MRI evidence of extraprostatic disease our organ confined disease rate would have improved by 16.6%. However, this improvement would have been obtained at the expense of incorrectly excluding from surgery 21% of our patients with pathologically organ confined disease because of false-positive MRI predictions.nnnCONCLUSIONSnEndo-rectal coil MRI is not sufficiently accurate to influence the treatment of patients with clinically localized prostate cancer. Therefore, we advise against routine use of this imaging modality in staging such cases.

Prediction of pathologic stage and postprostatectomy disease recurrence by dna ploidy analysis of initial needle biopsy specimens of prostate cancer

Background. DNA ploidy determination of carcinomas in radical prostatectomy specimens has shown significant correlation with patient outcome, but the predictive value of ploidy status of cancers obtained by transrectal ultrasound‐guided needle biopsies has not been studied extensively.

Pelvic lymph node visualization with MR imaging using local administration of ultra-small superparamagnetic iron oxide contrast

To determine if interstitial injection of iron oxide particles improves visualization of pelvic lymph nodes at magnetic resonance imaging (MRI) and to determine the effect of injection site on location of visualized nodes.

Ultrasound assessment of testicular and paratesticular masses

This article discusses the role of ultrasound in the workup of patients with suspected or palpable scrotal masses. By characterizing masses as intra‐ or extratesticular, the differential diagnosis can be narrowed considerably. Neoplasm is the primary concern with intratesticular masses, although non‐neoplastic conditions, such as hematoma and focal orchitis, may have a similar appearance. Correlation with the patients history is essential. The sonographic presentation of extratesticular pathology, including varicocele and masses of epididymal origin, is also described.

Prostate cancer: the diagnostic dilemma and the place of imaging in detection and staging

Prostate cancer is the most common malignancy in the world and, except for skin cancer, the most frequently diagnosed. It has been suggested by autopsy studies that approximately 30±50% of men worldwide harbor latent prostate cancer by their 50th birthday and that over 80% of men have the cancer by their 80th year of life [5, 23]. Although latent cancer does not necessarily imply biological potential, in the United States and other developed Western nations, prostate cancer has become the most frequently diagnosed clinical cancer [14]. In the United States, over 340,000 cases are diagnosed annually, far surpassing the numbers of the next most frequently diagnosed cancer. Many years ago it surpassed breast cancer in the number of new cases found each year. Today, over 50% more cases of prostate versus breast cancer are found annually [14]. There has been controversy regarding the appropriateness of early detection of prostate cancer. Since many of these tumors may not harbor lethal potential, early diagnosis may result in inappropriate treatment. However, prostate cancer is a major health problem throughout the world, particularly in the more developed Western nations. For example, although many men with diagnosed prostate cancer may not sux80er severe consequences, the disease has become the second most lethal cancer in American men, with over 42,000 dying annually from the malignancy [14]. As men are living longer, prostate cancer has become a more signi®cant health problem. More men are dying each year from prostate cancer and the numbers are increasing dramatically [2, 14, 24, 25]. Earlier diagnosis will allow the clinician to determine if treatment is indicated and should result in lower mortality from the disease. How do we diagnosis this disease? How do we evaluate the man who has newly diagnosed cancer and requires appropriate treatment? How do we treat prostate cancer? How is imaging used in the evaluation of prostate cancer? Until the mid-1980s, most prostate cancer was diagnosed by a digital rectal examination (DRE). In general, the DRE cannot diagnose microscopic and small prostate cancer. It is best used to identify larger cancers often tumors that have spread beyond the con®nes of the prostate to regional and distant lymph nodes and beyond. In the 1960s, with the DRE as the mainstay of diagnosis, most prostate cancers had spread beyond the con®nes of the gland at the time of diagnosis. At these stages, life expectancy and quality of life are compromised [6, 7, 11]. With the development of new diagnostic techniques, in particular, prostate-speci®c antigen, most cancers are now being found while they are limited to the prostate. The DRE should not be considered normal or abnormal but, more appropriately, normal or not normal. Subtle deviations from normal, for example, asymmetry in size, shape, texture, and nodules as well as distinct bulges or masses, should raise ones suspicion that tumor is possibly present. Although the DRE remains essential and should be performed annually, at least beginning at the age of 50 years, it is not the only diagnostic tool [12]. In the early 1980s a glycoprotein, prostate-speci®c antigen (PSA), was isolated and an assay was developed to measure its levels in the serum. However, this assay was not used extensively in clinical applications until the latter half of the decade. This relatively low-molecularweight glycoprotein is made exclusively by prostatic tissue and leaks into the serum. The amount of circulating PSA varies, depending upon the amount of prostate tissue, the pathologic processes involving the gland, and manipulation of the gland, i.e., biopsy or resection. PSA is elevated in some cancers, benign prostatic hyperplasia (BPH), prostatitis, and prostatic infarct. Some of these processes may occur concurrently and, thus, PSA cannot be used as an absolute measure but only as a relative guide as to the presence of pathology [1, 4, 9]. World J Urol (1998) 16: 76±80 Ó Springer-Verlag 1998

ULTRASOUND EVALUATION OF THE ANAL SPHINCTER IN FECAL INCONTINENCE

Fecal incontinence due to anal sphincter disruption is a relatively common process affecting 2% of the population. While non imaging modalities have been utilized in the past, the recent development of endoanal ultrasound to evaluate the integrity of the anal sphincter is now becoming more commonly employed. Disruption of the sphincter using endoanal ultrasound techniques is accurately diagnosed in a high percentage of patients. In many instances, endoanal ultrasound has replaced or is used as an adjunct to non imaging techniques. This article discusses the clinical and imaging characteristics of fecal incontinence due to anal sphincter disruption.