1. Role of MRI and MRSI in The Management of Prostate Cancer Karim Touijer, MD

2. Case Scenario Healthy 59 y/o male PSA: 3.4 ng/ml DRE: cT2a Left Mid and Apex induration Biopsy: Gleason 7 (4+3) Left Mid and Apex 2/6 cores positive, 70% involvement Nomogram Predictions: OC 47%, ECE 45%, SVI 6%, LNI 2%

5. Transurethral Resection of the Bladder

6. Role of the MRI Disease Staging Treatment planning Repeat Biopsy Diagnosis of local recurrence after surgery

7. Retrospective review 612 MRI/MRSI Clinical information was available to the radiologist at the time of MRI Predictions of staging given by the radiologist Compared to the Partin tables predicted probability This study needs to be reproduced by others

8. 135 patients – 270 NVB Pre MRIPre MRI Treatment plan: 1 preserve -------5 resect Post MRIPost MRI Treatment plan: - Unchanged - More conservative - More aggressive Pathology results as a standard referencePathology results as a standard reference

9. 13%

10. 31%

11. 37%42%

12. Overall The MRI did Improve the Surgeons’ Decision to Preserve or Resect the NVB

13. 61 y/o, cT2a, Gl 7, PSA: 5.4 Pre MRI: Probable Preservation 60 y/o cT1c, Gl 9, PSA: 8.45 Pre MRI: Probable Preservation

14. Anterior Tumors Preoperative features of anterior prostate tumors can underestimate the volume and extent of disease Lower clinical stage More negative prostate biopsies in the past Lower number and proportion of positive biopsy cores More favorable PFP prediction using contemporary prediction instruments.

15. Trends in Anterior tumors at MSKCC from 2000 to 2003

17. Conclusion 344 patients with prostate cancer Prediction of ECE by nomogram vs.MRI read by GU radiologists Prediction of ECE by nomogram vs. MRI read by general radiologists

18. Genitourinary Radiologists General radiologist

19. Conclusions MRI is a helpful tool in staging and treatment planning. MRI adds extra-information to the already existing tools MRI interpretation is highly dependent on the experience of the reader Accurate imaging of prostate cancer is an important step towards focal therapy for prostate cancer