Prostate Cancer is a bugabear–over or under treatment is the problem

This paper recommends MRI PET as better for deciding the nature of the malignancy.

In my experience prostate cancer has been over treated and undertreated, radical prostatectomy is a big operation, conservative medical treatment can be a mistake with an aggressive hyper malignant cell type, both with bad consequences for the patient.

I just put this up as a reminder, prostate cancer is indolent for many patients, who will die of other problems before the prostate cancer gets em. Some should be treated conservatively, but you don’t want to miss the bad boys. Prostate Specific Antigen (PSA) is not enough to figure it out. I am not a urologist and appreciate the dilemma for them on this one.

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Combined PET/MRI in Prostate Cancer Improves Diagnostic Accuracy
Research · April 24, 2014


In this prospective clinical trial, the combined use of 18F-fluoroethycholine PET and endorectal MRI was superior to either modality alone in identifying dominant malignant lesions of the prostate. The combination also appeared to improve differentiation between Gleason ≤ 6 and > 6 tumors.
This combined imaging approach appears to provide significant benefit over either modality alone and may help define and distinguish malignant prostate lesions. Further study is warranted.


The pretherapeutic assessment of prostate cancer is challenging and still holds the risk of over- or undertreatment. This prospective trial investigates positron emission tomography (PET) with [18F]fluoroethylcholine (FEC) combined with endorectal magnetic resonance imaging (MRI) for the assessment of primary prostate cancer.


Patients with prostate cancer based on needle biopsy findings, scheduled for radical prostatectomy, were assessed by FEC-PET and MRI in identical positioning. After prostatectomy, imaging results were compared with histological whole mount sections, and the PET/MRI lesion-based semiquantitative FEC-uptake was compared with biopsy Gleason scores and postoperative histology.


PET/MRI showed a patient-based sensitivity of 95% (36/38; 95%CI: 82-99%). The analysis of 128 prostate lesions demonstrated a sensitivity/specificity/ppv/npv/accuracy of 67%/35%/59%/44%/54% (P=0.8295) for MRI and 85%/45%/68%/69%/68% (P=0.0021) for PET, which increased to 84%/80%/85%/78%/82% (P5mm (n=98). For lesions in patients with Gleason >6 tumors (n=43), MRI and PET achieved 73%/31%/71%/33%/60% (P=1.0000) and 90%/62%/84%/73%/81% (P=0.0010), which were improved to 87%/92%/96%/75%/88% (P6 were distinguished from those with Gleason ≤6 with a specificity of 90% and a PPV of 83% (P=0.0011) (needle biopsy 71%/60%, P=0.1071).


In a prospective diagnostic trial setting, combined FEC-PET/MRI achieved very high sensitivity in the detection of the dominant malignant lesion of the prostate, and markedly improved upon PET or MRI alone. Non-invasive Gleason score assessment was more precise than needle biopsy in this patient cohort. Hence, FEC-PET/MRI merits further investigation in trials of randomized, multi-arm design.

Clinical Cancer Research
Combined PET/MRI Improves Diagnostic Accuracy in Patients With Prostate Cancer: A Prospective Diagnostic Trial

Clin. Cancer Res 2014 Apr 24;[EPub Ahead of Print], M Hartenbach, S Hartenbach, W Bechtloff, B Danz, K Kraft, B Klemenz, C Sparwasser, M Hacker
This abstract is available on the publisher’s site.

One response to “Prostate Cancer is a bugabear–over or under treatment is the problem

  1. This is an important post John. Thanks. Many chaps have panicked over this condition. My recommendation always is to see a very experienced and smart urologist who is in cohorts with a top surgeon (if required). Often surgery is NOT required. Gleason score is important – over 8 certainly not good. But this latest advance is great news. Let’s follow it up. This type of cancer is very nasty if it gets out of the prostate and into the bone. A wise doctor is needed.

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