The potential role of prostate MRI has in recent years expanded significantly, and there is great hope that mpMRI can help address two major problems encountered when treating prostate cancer: overtreatment and understaging.
While there are many surgeons who do not believe in using pre-operative magnetic resonance imaging (MRI) to aid in decision-making and fine-tuning a nerve-sparing technique, there are a few leading institutions and surgeons, including Dr. Tewari, who are very deeply engaged in developing imaging for prostate cancer so that every patients has the best shot for nerve sparing. No two people are the same. Our bodies don't look alike externally, so why should we think that our internal anatomy would be alike?A preoperative evaluation of the nerves,their location in relation to the cancer, and the shape and details of the nerve hammock help Dr. Tewari individualize the surgery and not use a one-size-fits-all approach. A surgical technique that is measured and planned for a unique individual is likely to have a better outcome than one that treats every anatomy as "off the shelf"! Dr. Tewari has debated his position-in favor of use of imaging-in front of thousands of leading urologists and is a believer in planning MRI.
Prostate cancer with extraprostatic extension. (a) Axial and coronal (b) T2 weighted images demonstrate extraprostatic extension in the left lateral base invading left neurovascular bundle. There is also seminal vesicle invasion (marked in red) as seen on axial T2WI obtained more superiorly (c).
Localization of prostate cancer using multiparametric MRI combining T2WI, DWI and DCE (a)T2 weighted image shows hypointense lesion in right peripheral zone (arrow). (b) Corresponding ADC map shows restricted diffusion with low ADC in tumor compared to normal peripheral zone. (c) a Color coded map obtained with DCE-MRI overlaid on T2WI shows marked enhancement in the same region, as well as hypervascularity in central gland.
To this end we are developing novel mpMRI based neural networks which will help in:
1. Improving the accuracy for diagnosing prostate cancer
2. Grading of prostate cancer
3. Staging of prostate cancer