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Helical CT of Prostate Cancer

Early Clinical Experience

¹ Radiological Center of Campinas, Av. Andrade Neves, 707, Campinas-S.P.-Brazil 13013-161.
² Department of Diagnostic Radiology, Box 57, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.

View larger version (123K): [in a new window]   Fig. 1. —65-year-old man with normal findings on digital rectal examination and prostate-specific antigen of 7.5 ng/mL. Helical CT scan of prostate shows normal appearance of peripheral zone as band of hypodense tissue (arrows). Note usual appearance of symmetric, contrast-enhanced nodules of hyperplastic tissue in central gland (H).

View larger version (115K): [in a new window]   Fig. 2. —68-year-old man with abnormal findings on digital rectal examination and prostate-specific antigen of 10.5 ng/mL. Helical CT scan shows area of focal abnormal contrast enhancement in mid portion of left peripheral zone (arrow). Note lack of findings in right peripheral zone lesion. Transrectal sonographically guided biopsy (not shown) revealed prostatic adenocarcinoma (Gleason score of 6 in mid portion of left peripheral zone) and foci of adenocarcinoma (Gleason score of 5 in right peripheral zone).

View larger version (114K): [in a new window]   Fig. 3. —60-year-old man with positive digital rectal examination and prostate-specific antigen of 6.5 ng/mL. Transrectal sonographically guided biopsy detected adenocarcinoma, Gleason score of 6 in left apical portion of peripheral zone. Helical CT clearly shows focal area of contrast enhancement (arrow) in same area where cancer was detected.

View larger version (93K): [in a new window]   Fig. 4. —58-year-old man with abnormal findings on digital rectal examination and prostate-specific antigen of 15 ng/mL. Helical CT shows extensive area of intense abnormal contrast enhancement in posterior and left portion of peripheral zone (arrows) (adenocarcinoma of prostate with Gleason score of 8 at transrectal sonographically guided biopsy).

View larger version (104K): [in a new window]   Fig. 5A. —68-year-old man with positive findings on digital rectal examination and prostate-specific antigen of 12 ng/mL. Transrectal sonographically guided biopsy detected adenocarcinoma, Gleason score of 8 in right peripheral zone, and Gleason score of 7 in left peripheral zone. Helical CT shows focal area of contrast enhancement in right peripheral zone of prostate (arrow).

View larger version (106K): [in a new window]   Fig. 5B. —68-year-old man with positive findings on digital rectal examination and prostate-specific antigen of 12 ng/mL. Transrectal sonographically guided biopsy detected adenocarcinoma, Gleason score of 8 in right peripheral zone, and Gleason score of 7 in left peripheral zone. Note abnormal contrast enhancement of contiguous neurovascular bundle (arrow), suggestive of tumor involvement, which was confirmed on transrectal MR imaging.

View larger version (125K): [in a new window]   Fig. 6. —58-year-old man with negative digital rectal examination and rising prostate-specific antigen levels in last 3 years who had undergone three sets of transrectal sonographically guided biopsies (including transitional zones) with negative results. His recent prostate-specific antigen level was 18 ng/mL. Helical CT scan of prostate shows small area of abnormal contrast enhancement in posterior portion of right peripheral zone (arrow), suggestive of cancer. Repeated transrectal sonographically guided biopsy with particular emphasis to this area (six core biopsy samples) allows detection of adenocarcinoma in 50% of only one core biopsy sample and Gleason score of 6. No other focus of tumor was found (total of 14 core biopsy samples).

View larger version (149K): [in a new window]   Fig. 7. —68-year-old man with abdominoperineal resection and prostate-specific antigen level of 16 ng/mL. After helical CT of prostate that showed suspicious area of abnormal contrast enhancement in mid portion of right peripheral zone, transgluteal percutaneous biopsy of this suspicious area allowed detection of adenocarcinoma with Gleason score of 6.

View larger version (113K): [in a new window]   Fig. 8. —63-year-old man who underwent abdominal and pelvic CT for staging non-Hodgkin's lymphoma. Helical CT of pelvis revealed abnormal contrast enhancement in right peripheral zone of prostate with capsular bulging (arrows). Note adenopathy also in inguinal regions (asterisks). Transrectal sonographically guided biopsy revealed adenocarcinoma with Gleason score of 8 in both peripheral zones. Prostate-specific antigen level (15 ng/mL) was then obtained.

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