Correspondence

MRI-Guided Diagnosis and Treatment of Prostate Cancer

N Engl J Med 2001; 344:776-777March 8, 2001

Article

To the Editor:

In the United States, the most common method for diagnosing prostate cancer is a transrectal ultrasound-guided needle biopsy of the prostate gland. However, the positive predictive value of this method is only 18 percent.1 We used a real-time, intraoperative magnetic resonance imaging (MRI) guidance system (General Electric, Milwaukee)2 to diagnose and treat prostate cancer in a 62-year-old man with a rising prostate-specific antigen level. The patient was not a candidate for a transrectal ultrasound-guided prostate biopsy because of a previous proctocolectomy for ulcerative colitis.

For the diagnosis, we used a real-time, intraoperative 0.5-T MRI system2 and a three-dimensional slicer3 to guide the biopsy needle to the exact location of the lesion (Figure 1AFigure 1Images Obtained during MRI-Guided Diagnosis and Treatment of Prostate Cancer in a 62-Year-Old Man. and Figure 1B), which had been noted on a 1.5-T endorectal MRI scan obtained before the biopsy. The biopsy specimen contained a moderately differentiated adenocarcinoma (Gleason score, 6); the tumor involved 30 percent of the specimen.

The patient elected to be treated with brachytherapy, which could be performed with the MRI system2 because, unlike transrectal ultrasound guidance, MRI guidance involves apparatus that is extrinsic to the patient and does not require the presence of a rectum. The treatment involved transperineal placement of needles that contained radioactive sources and an assessment of the position of each needle in the coronal, sagittal (Figure 1C), and axial planes. At the completion of the procedure on line, real-time dosimetry permitted the placement of additional radioactive sources in areas of underdosing due to displacement of the catheter that could not be corrected intraoperatively. This procedure permitted us to achieve 100 percent dose coverage within the prostate without exceeding the maximal allowable doses for the normal surrounding tissues. Both the biopsy and the brachytherapy were well tolerated by the patient.

We are conducting prospective trials to determine whether the more precise placement of the biopsy needle and of radioactive sources achieved with MRI guidance than with transrectal ultrasound guidance will improve the diagnosis and treatment of prostate cancer.

Anthony V. D'Amico, M.D., Ph.D.
Robert A. Cormack, Ph.D.
Clare M. Tempany, M.D.
Brigham and Women's Hospital, Boston, MA 02115

3 References

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    K. Chinzei, S.K. Warfield, N. Hata, C.M.C. Tempany, F.A. Jolesz, R. Kikinis. (2003) Planning, simulation and assistance with intraoperative MRI. Minimally Invasive Therapy & Allied Technologies 12:1-2, 59-64
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