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E2175. Problem Solving in Prostate Cancer: Acquisition, PI-RADS, Pearls, and Pitfalls
Authors
  1. Akram Sadeghi; Morristown Medical Center
  2. Derrick Tran; University of Oklahoma Health Sciences Center
  3. Justin Alpert; Morristown Medical Center
Background
Prostate cancer is one of the most common malignancies in men. Indolent in its growth, prostate cancer can be notoriously difficult to detect. This makes radiologists uniquely adaptable to serve as the first line of defense in the detection of prostate cancer. New technologies are being developed every day in the battle against cancer, pushing the boundaries of treatment. Whether it is new imaging technique, innovative molecular therapies, or novel endovascular treatments, radiologists are at the center of prostate cancer treatment. However, the sword is only as good as its wielder, and familiarization with the normal, variant, and abnormal is the key in the detection of prostate cancer using our latest imaging techniques. The goal of this educational exhibit is to help simplify a complex topic, especially useful for the resident radiologist.

Educational Goals / Teaching Points
The purpose of this exhibit is several, but is chiefly to provide a foundation upon which residents can use for problem-solving when approaching prostate cancer imaging. Initially, a review of normal multi-modal imaging of pelvic anatomy pelvic anatomy with multimodal imaging. There will be an emphasis on anatomical consideration that impact management. Prostate MRI protocols will be reviewed, and how to approach prostate cancer imaging. Using cases at our institution, these concepts will be applied in a straightforward fashion leading and assisting the viewer to formulate a differential diagnosis and how to separate malignancy from other benign conditions such as prostatitis and hyperplasia. As MRI of the prostate becomes more accessible at more imaging centers, and with patients being referred for screening, the PI-RADS system enables radiologists to communicate in a standardized manner to other clinicians for the best patient care.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Separating the benign from the malignancy is challenging, but can be helped with a stepwise approach to imaging. MRI is the gold standard for prostate imaging. Identifying normal signal characteristics of the prostate and surrounding anatomical structures will assist in localizing the abnormality. Careful evaluation of the capsule, apex, neurovascular bundles, and nearby extra-prostatic structures such as the seminal vesicles pays dividends for the patients and their clinicians. Artifacts are encountered in every imaging modality, and prostate MRI is no different. Sometimes, the differentiation from benign entities is difficult, and can lead to frustration. However, by being familiar with these concepts, radiologists can best serve their patients.

Conclusion
Radiologists are in a unique and exciting position at this time in prostatic imaging. As technology advances, so do our weapons in the fight against prostate cancer. By establishing a solid foundation and familiarization of the principles of prostatic imaging, the features of prostate cancers, and differentiating it from benign entities, radiologists worldwide can help advance the science of prostate cancer detection and treatment.