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Citrate

Choline

Polyamines

Pol/amin

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Choline

Polyamines

Pol/amin

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FIGURE 3.7. MR spectroscopy—MR spectral trace from (A) normal peripheral zone prostate tissue and (B) Gleason 7 peripheral zone prostate cancer (With permission from Elsevier—Coakley, J Urology, Vol 170,

FIGURE 3.7. MR spectroscopy—MR spectral trace from (A) normal peripheral zone prostate tissue and (B) Gleason 7 peripheral zone prostate cancer (With permission from Elsevier—Coakley, J Urology, Vol 170,

• There is emerging evidence that, in patients with an abnormal PSA and negative prostate biopsies, MRSI can aid localization and increase the positive yield of subsequent biopsies

• MRSI is superior to standard MRI in the estimation of tumor volume and detection of capsular/extracapsular involvement (detection rate up to 83%) thereby influencing treatment options. Its main role may well be confined initially to the grading of prostate tumors

• MRSI localization techniques have been used to increase radiation dosage (brachytherapy or external beam) to areas of the prostate with alleged carcinoma

• In treatment failures, MRSI can detect residual tumor following failed radiotherapy and androgen deprivation therapy (detection less favorable following radical prostatectomy). It may also help discriminate between residual/recurrent tumor and benign necrotic/fibrotic tissue following cryosurgery

• Certain cancers may be characterized as high-grade based on spectroscopic patterns and may subsequently respond poorly to treatment

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