Prostate Cancer: Pathophysiology and Diagnostics

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Table of Contents

Introduction
Pathophysiology
Endorectal coil
Phased array coil
Magnetic Resonance spectroscopy (MRS)
References

Introduction

Prostate cancer is an illness whereby cancer develops in the gland called the prostrate which is found in the male reproductive system. It is caused by the transformation of the prostate cells when they start to multiply out of control. The cells may multiply to all other parts of the body from the prostrate particularly to the lymph nodes and in the bones. (Ammy, 2003)

The effects of prostate cancer include complexity in urinating, erectile dysfunction, pain, and other symptoms. Prostate cancer rates differ widely across the world. However, the rates vary widely between countries and this is indicated by the difference in prevalence rates between countries in East and South Asia where it is less common to the United States and Europe where it is most common.

The sickness is least common among Asian men but it is more widespread in black men according to the American cancer society. Rising rates of findings may affect the high rates. The prostate tumor develops slowly but it is more widespread with men aged fifty and over.

It is an infection that occurs in men alone because the prostate gland is solely found in the men’s reproductive tract. Prostate cancer is a disease that results in numerous deaths in men than any other cancer with the exemption of lung cancer. The disease is often revealed in the course of physical inspection or through blood tests such as prostate-specific antigen (PSA). The present concern about the truth of PSA tests has risen particularly in its expediency.

Pathophysiology

Adenocarcinomas make up about 95% of the prostate cancers that build up in the acini of the prostatic duct. The extra types of histopathologic cancers in the prostate gland crop up in 5% of the victims and these consist of mucinous, endometrioid carcinoma, squamous cell carcinoma, transitional cell carcinoma, adenoid cystic carcinoma, neuroendocrine carcinoma, and the signet ring carcinoma.

The disease is normally multimodal in the prostate gland and just about 70% of the illness exists in the (PZ) or the Peripheral zone. In the transition zone is found 20% of the ailment. As observed by some authors transitional zone prostate cancer is comparatively less aggressive but they have reiterated that the peripheral zone is more destructive and it has damaging effects on the periprostatic tissues.

Biopsy strategies that are up-to-date focus more on the peripheral zone cancer and principally disregard transitional zone cancer. A study carried out on 147 patients with prostate cancer which was built on radical prostatectomy specimens showed that 80% of the transitional zone tumors were restricted in the organ. A less important tumor was found in the peripheral zone in 54% of the cases. Just about 15% of the cases had infiltration in the capsular, 2.6% attack in the seminal vesicle and 3.4% had lymph nodes metastases.

The tumor, node, metastases (TNM) staging structure was revised in 1997 and it is the worldwide standard for the staging of prostate cancer through this method prostate cancer is categorized as T1 and T2.

The T1 is a standard used in detecting tumors that is clinically inapparent and is not observable or palpable by imaging. It is commonly used in the subsidiary histologic discovery of 5% or less of tumor and this is prepared through a tissue that is obtained at some stage in the resection of the transurethral for symptoms of outflow region obstruction. In this case, the standard is classified as T1a.T1b consists of the secondary histologic result of more than 5% of the resected tissue.T1c consists of the tumor that is recognized by the biopsy needle that is carried out because of the PSA levels that are elevated. T2 is used on the tumor that is limited in the prostrate.

It is also divided into T2a, and T2b.T2a is performed on the tumor that involves one lobe while T2b is used in the tumor that involves both lobes. The implications and the restraints of the massive weighted images such as the T1 and the T2 are that they are more responsive to defects of the brain since the signals will show the hyper signal foci when the cerebrospinal fluid hypointense and this is based on the TE value. T2 weighted images cause averaging that is partial.T2 weighted imaging is used when using the multishot (EPI), that is, Echo Planner Imaging for easy visualization of cancer in the prostate. This is because using the T2 weighted imaging for prostate cancer imaging using the EPI gives a high-quality contrast resolution as compared to any other method. T1 weighted imaging is made use of in detecting the brain metastases due to its high sensitivity both after and before the contrast material administration. In this perspective T1, weighted imaging is superior to T2 for imaging hemorrhage in the prostrate because it demonstrates higher brain tissue contrast and it is also sensitive to contrast enhancement.

Endorectal coil

The endorectal coil is a form of imaging made use of in medicine whereby MRI is used in combination with a coil that is positioned in the rectum for the reason of getting high-quality images of the adjacent areas to the rectum. High exactness has been confirmed by the system than any other modalities that have been used in assessing the attack of the seminal vesicle and extracapsular extension, (ECE).

The endorectal coil is incredibly helpful in the determination of the level of increase and local attack of cancer in the rectum, prostate, and anus. The coil is made of a probe that contains an inflatable balloon which serves the function of maintaining the suitable position. Coils like the endorectal coil may be used in the vagina for the function of evaluating cervical cancer.

Phased array coil

This coil operates characteristically as a receiver coil which means that the MRI device implemented body coil functions as the spreader and it sends the frequency energy to produce the excitation pulses. The state of art array is made use of in the coils system which is composed of 4 or up to 32 coils that have detached and discrete receivers.

This method is called the phased arrays system even though the signals are not added such that the signal phase information is encompassed. The utilization of the phased array coil allows the declining of the amount of the signals averages that reduces the time used in scanning by high SNR and the resolution.

The phased array coil and the endorectal coil have several implications in the anatomical and prostrate cancer staging performance. First, they are used in both male and female cancer discovery since they allow for the detection of any cancer effects that may be adjacent to the cervix as well as the prostate. The harmful implication of the two is that they are dangerous and are responsive to delicate body organs such as the lungs and the brain. (Peters, 1999)

In the examination of the univariate EOD serum prostrate exact antigen intensity, the hemoglobin intensity as well the serum alkaline phosphatase level are considerably linked with the continued existence of the ailment while the local extent and the tumor size are not linked with the disease specific continued existence. Another implication is that it becomes hard for the patients to tolerate and it is sometimes irritating. There are many harmful implications but the most critical are experienced in the lapse of the time allowed. (Duna, 1995)

Dynamic Contrast Enhanced (DCE) is known for its control in vascularity, detection and visualizing of solid tumors such as the musculoskeletal and the breast tumors. Further information has been seen to be availed by the DCE-MRI of the prostrate gland. Preceding sequence on the use of the Dynamic Contrast Enhanced for localization of cancer was strictly limited in a few of at least one slice and they are used based on the T2 weighted images results. (Casciani, 2004)

This method allows the complete visualization that leads to a degree of operator reliant instituted in the slice selection. Dynamic Contrast Enhanced has been seen to be the efficient and responsive modality for testing elevated risks in women. (CAD) which is a computer supportive analysis method has the likelihood of backing up the radiologists in the premature discovery of any type of cancer. The most vital constituent in the improvement of the CAD system is the choice of a proper categorization function that is in charge of sorting out benign and malignant lesions.

The predictable Conventional contrast Enhanced MRI has in the recent past gained escalating interest owing to its superiority in sensitivity and in the extra physiologic information that is provided by the contrast development.

It is used in complementing the predictable imaging and it is suitable since every time predictable contrast procedure is used in the clinics for the work of analytical problems such as work up of a focal lesion and exclusion of multifocality, the thin slices are used to guarantee nonexistence of partial volume consequence which encompasses both specifity and sensitivity.

Magnetic Resonance spectroscopy (MRS)

Magnetic resonance spectroscopy (MRS) is used in measuring the different substances in the tissue and it differentiates between benign and malignant. It allows the vivo exploration and noninvasive exploration of the tissue’s molecular composition. (Duna, 1995).It helps in identification of the metabolites, that is, molecular constituents that are involved in the pathological or physiological processes. The most widely used MRI is the spectroscopy of the hydrogen not forgetting that also spectroscopy can be carried out on different nuclei. It is a medical imaging technique that is used commonly in radiology which helps in visualizing the function and the structure of the body. Given any plane the magnetic resonance spectroscopy offers detailed images of the body. As opposed to the computed tomography, magnetic resonance spectroscopy offers a greater contrast between the soft tissues of the body. It is therefore mostly used in the neurological, cardiovascular, musculoskeletal and the oncological imaging. (Casciani, 2004)

References

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Aumüller, G. (1979). Prostate Gland and Seminal Vesicles. (Berlin-Heidecool.lberg: Springer-Verlag).

Casciani E, et al (2004). “Prostate cancer: evaluation with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging”, (Oxford: Oxford University Press).

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Duna G. (1995).Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system, (New York: New York Press).

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Hricak H, et al (1994). “Carcinoma of the prostate gland: MR imaging with pelvic phased-array coils versus integrated endorectal-pelvic phased-array coils, (New York: Macmillan publishers).

Kumar, V. (2004). Robbins & Cotran Pathologic Basis of Disease,(New York: Philadelphia).

Leitzmann, M. et al (2004), “Ejaculation frequency and subsequent risk of prostate cancer” (New York: McGraw Hill).

Perez, C. et al (1998). “Localized carcinoma of the prostate, (Oxford: Oxford University Press).

Peters U, et al (1999). “American Brachytherapy Society Recommendations for Transperineal Permanent Brachytherapy of Prostate Cancer, (New York: New York Press).

Potosky A, et al (2006). “The role of increasing detection in the rising incidence of prostate cancer“, (Oxford: Oxford University Press).

Pomper, M. (2001). CNS vasculitis in autoimmune disease: MR imaging and correlation with angiography, (New York: New York Press).

Taber’s, C. Medical Dictionary, (New York: Philadelphia).

Wasserman, B.et al (2001).Reliability of normal findings on MR imaging for excluding the diagnosis of vasculitis of the central nervous system, (Berlin-Heidecool.lberg: Springer-Verlag).

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