1. Genitourinary Imaging-----Prostate
Xiaotao Cai

2. Applied Anatomy and Normal Imaging Manifestation
Male genital organs
Various external and internal male organs concerned with reproduction.

3. rectum
seminal vesicle
urethra
Male genital organs
Schematic drawing

4. Male genital organs Urinary bladder Urinary bladder,neck
Urinary bladder,trigone
Urethra, prostatic
Urethra, membranous
Urethra, penile
Urethra, male
Urethra, bulbous
Radiograph, contrast mediam,micturating urethrocystogram, AP projection

5. Normal CT Manifestation
1 prostate gland： size
older   5 Cm
younger   3 Cm
2 seminal vesicle

6. Male genital organs
transection
bladder
seminal vesicle

7. Male genital organs

8. Male genital organs prostate

9. MR Imaging Appearance of Normal Prostate Anatomy
On T1WI, the normal prostate gland demonstrates homogeneous intermediate-to-low signal intensity.
As with computed tomography (CT), T1WI has insufficient soft-tissue contrast resolution for visualizing the intraprostatic anatomy or abnormality.
The zonal anatomy of the prostate gland is best depicted on high-resolution T2WI

10. Normal Prostate Anatomy
T2WI：
Transitional Zone
Central Zone
Peripheral Zone
Anterior Fibromuscular Stroma
Prostatic Capsule

11. Normal Prostate
T2WI
T1WI
T2FS
T2WI
coronal plane

12. Male genital organs
seminal vesicle

13. Normal prostate zonal anatomy
A 60-year-old man
T2WI at the level of the seminal vesicles
at the base of the prostate
B = urinary bladder
C = central zone

14. Normal prostate zonal anatomy
A 60-year-old man
T2WI at the level of the mid-gland
FS = anterior fibromuscular stroma
P = peripheral zone
T = transition zone

15. Normal prostate zonal anatomy
A 60-year-old man
T2WI at the level of the apex
at the level of the membranous urethra
U = urethra

16. Normal prostate zonal anatomy
Normal prostate zonal anatomy in a 60-year-old man
T2WI corona, midsagittal, and parasagittal MR images
The letters in g correspond to the anatomic levels used for images a-f
The vertical line in g indicates the membranous urethral length. B = urinary bladder, C = central zone, P = peripheral zone, SV = seminal vesicles, U = urethra.

17. Male genital organs MRI, T1-weighted, axial section.
(serial sections, cranial to caudal)

18. Male genital organs MRI, T1-weighted, axial section.
(serial sections, cranial to caudal)

19. Male genital organsT1WI

20. Male genital organsT2WI

21. contrast-enhanced MR
On contrast-enhanced MR images, the peripheral zone enhances more than the transition or central zone.
The contrast resolution is similar to that seen on T2WI

22. prostate cancer outline Incidence:
doubles with each decade after age 50;
180,400 new cases + 31,900 deaths in USA (2000);
2nd most common malignancy in males (after lung cancer);
in 35% of men >45 years of age (autopsies) ;
One out of 11 males will develop prostate cancer!

23. Racial factors:8. 7% in White males, 9
Racial factors:8.7% in White males, 9.4% in Black males; less common in Asians
Risk factors: advancing age, cadmium exposure, animal fat intake; first-degree relative
Histology: adenocarcinoma (common);

24. Staging of Prostate Cancer American Urological Association System (modified Jewitt-Whitmore Staging System) A
No palpable lesion A1
focal well-differentiated tumor <1.5 cm A2
diffuse poorly differentiated tumor; >5% of chips from transurethral resection contain cancer B
Palpable tumor confined to prostate B1
lesion <1.5 cm in diameter confi ned to one lobe B2
tumor 1.5 cm / involving more than one lobe C
Localized tumor with capsular involvement C1
capsular invasion C2
capsular penetration C3
seminal vesicle involvement D
Distant metastasis D1
involvement of pelvic lymph nodes D2
distant nodes involved D3
metastases to bone / soft tissues / organs

25. Clinical categories:
Latent carcinoma = usually discovered at autopsy of a patient without signs or symptoms referable to the prostate ;
Incidental carcinoma = discovered in of specimens obtained during transurethral resection for clinically benign prostatic hyperplasia ;
Occult carcinoma = found at biopsy of metastatically involved bone lesion / lymph node in a patient without symptoms of prostatic disease ;
Occult carcinoma = found at biopsy of metastatically involved bone lesion / lymph node in a patient without symptoms of prostatic disease

26. elevated Prostate-Specific Antigen (PSA)
is measured by a monoclonal radioimmunoassay
Cancers of <1 mL usually do not
16% of normal men have PSA >4 ng/mL
19% of prostate cancers have normal
Benign conditions with PSA elevation: benign prostatic hypertrophy, prostatitis, prostatic intraepithelial neoplasia

27. MR Appearance of Prostate Cancer
low-signal abnormality within the normally high-signal glandular tissue of the peripheral zone on T2WI
tumor isointense relative to surrounding gland on T1WI
capsule optimally depicted on T1WI due to demarcation by high signal-intensity periprostatic fat
direct tumor extension beyond prostate

28. MR Appearance of Prostate Cancer
decreased signal intensity in periprostatic fat adjacent to capsule near the tumor on T1WI + T2WI
capsular thickening
irregular focal bulge in contour of capsule near the tumor
flattening / obliteration of rectoprostatic angle

29. MR Appearance of Prostate Cancer
asymmetry of neurovascular bundle
low-signal lesion on T2WI within seminal vesicles that are normally of high-signal intensity

30. Biopsy-proved adenocarcinoma
A 71-year-old man with a PSA level of 5.65 ng/mL
axial T2WI and coronal T2WI show that the dominant tumor (T) within the left peripheral zone extends from the apex to the base. Obliteration of the left rectoprostatic angle is indicative of extracapsular extension.
Findings at surgery and histopathologic examination helped confirm a large tumor with extracapsular extension

31. Prostate cancer
T2-weighted axial MR images show an asymmetric bulge and spiculated margin
obliteration of the rectoprostatic angle

32. Prostate cancer
T2-weighted axial MR images show breach of the capsule with direct tumor extension and envelopment of the neurovascular bundle, and asymmetry of the neurovascular bundles

33. prostate cancer – transection T1WI

34. prostate cancer --T2WI

35. prostate cancer – sagittal plane T1WI pos-contrast

36. prostate cancer
sagittal plane T1WI pos-contrast

37. Biopsy-proved adenocarcinoma
A 58-year-old man with a PSA level of 50.0 ng/mL
T2WI axial and sagittal images reveal a large tumor (T) that invades the entire prostate gland and demonstrate gross extracapsular extension and direct invasion of the urinary bladder and seminal vesicles

38. Biopsy-proved adenocarcinoma
A 62-year-old man with a PSA level of 15.1 ng/mL
T2WI axial and sagittal images demonstrate diffuse tumor invasion of the prostate gland with direct tumor (T) extension to the wall of the urinary bladder and the anterior rectal wall. The multiple low-signal-intensity lesions in the pubic bones are consistent with bone metastases

40. Postbiopsy hemorrhage
axial T1WI and T2WI and coronal T2WI demonstrate extensive bilateral postbiopsy hemorrhage in the peripheral zones. The transition zone in the left lobe demonstrates high signal intensity on the T1WI and low signal intensity on the T2WI

41. DDx: post-biopsy hemorrhage (low signal on T2WI + high signal on T1WI)
Prognosis :increase in tumor volume increases probability of capsular penetration, metastasis, histologic dedifferentiation
Mortality :2.6% for White males, 4.5% for Black males; 34,000 deaths/1992

42. Screening recommendation (American Urological Association, American Cancer Society):
PSA level measurements + digital rectal exam annually
Rx:(1) Watchful waiting (2) Radical prostatectomy for disease confined to capsule + life expectancy >15 years (3) Radiation therapy for   (a) disease confined to capsule, life expectancy <15 years   (b) disease outside capsule, no spread (4) Hormonal therapy (orchiectomy, diethylstilbestrol, leuprolide acetate) for widely metastatic disease (5) Cryosurgery (6) Chemotherapy

43. benign prostatic hyperplasia (BPH)
The prostrate is a small male gland the size of a walnut that is found at the base of the bladder which surrounds the neck of the bladder and the urinary outlet known as the urethra.
Benign prostatic hyperplasia (BPH) which is also known as benign prostatic hypertrophy is the natural enlargement of the prostrate gland which typically happens to a man after the age of 40, it is non-malignant.
One in three men over 50 years of age will experience the symptoms associated with benign prostatic hyperplasia (BPH), the condition increases with age.

44. benign prostatic hyperplasia (BPH)
       The typical symptoms of a man who has Benign prostatic hyperplasia (BPH) are, a need to urinate more especially at night, difficulty with starting to urinate, a weak urinary stream which causes dribbling and starting and stopping whilst in mid flow and having a feeling of not emptying the bladder properly.
If the prostrate gland enlarges too much and urinations become too difficult or impossible than further complications may arise with kidney damage and urinary track infections.

45. benign prostatic hyperplasia (BPH)
         A change in diet in general does not help with Benign prostatic hyperplasia (BPH) but a change in lifestyle does, men who are more physically active tend to have less Benign prostatic hyperplasia (BPH) symptoms, walking is especially good.          The best supplements to take for benign prostatic hyperplasia (BPH) are extract of saw palmetto berries.         

46. prostatic hyperplasia

47. prostatic hyperplasia

48. prostatic hyperplasia

49. prostatic hyperplasia

50. THANKS FOR YOUR ATTENTION!