Feature article

Men's health matters: Imaging the prostate

Men's health has become an important awareness topic in the healthcare realm. As physicians and organizations push to raise awareness for a multitude of medical disorders, the awareness of issues with the prostate may be higher than ever. However, the public may not realize that men can have issues with their prostate that are not necessarily cancer-related. The prostate is a small gland that men have in their groin that women do not. There are a number of different issues that can affect the prostate, including cancer, benign prostatic hyperplasia, bacterial prostatitis and chronic prostatitis.1

What are some prostate problems that are unrelated to cancer?

Benign prostatic hyperplasia (BPH) also called prostate gland enlargement, occurs when the prostate becomes larger than it should be.2 BPH is a common condition that can occur as men age and can lead to urinary symptoms. Symptoms can be severe or mild no matter the size of the prostate and may eventually stabilize or improve. BPH can lead to bladder, urinary tract or kidney problems.

Bacterial prostatitis can be long- or short-lived.3 Acute bacterial prostatitis affects the patient for a short length of time. It is frequently caused by common strains of bacteria, and its treatment is antibiotics. If the disorder affects the patient for a longer period of time, is recurring or is difficult to treat, it may be considered chronic bacterial prostatitis. Prostatitis affects men who are young or middle-aged more than those who are older. Patients may have urinary symptoms, pain in the abdomen, groin or lower back, pain between the scrotum an rectum and flu-like symptoms. If left untreated, some cases of prostatitis may result in a worse infection or other health issues.

Chronic prostatitis occurs similarly to bacterial prostatitis.3 In fact, it includes chronic bacterial prostatitis and prostatitis without a known cause. If the cause of the patient's prostatitis is unknown, their physician may decide that it would be best to treat the symptoms instead of the disorder.

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MRI techniques used to image the prostate

Magnetic resonance imaging (MRI) is a type of medical imaging scan that produces detailed images of the inside of a patient's body. The images can depict tissue structures, organs or blood flow both conventionally and with a variety of different advanced techniques. The magnet inside the scanner is a super-conducting magnet, allowing the scanner to control the magnetic field inside and around the device. Throughout the scan, the patient is placed inside the scanner. Their body releases signals in response to pulse sequences run by the radiologist and their computer. These signals are interpreted and used to create the images that the radiologist uses.

Prostate MRI may require a conventional scan, as described above, or it may require some more advanced methods, depending on what the doctor is imaging.4 One of the most common types of MRI used for prostate imaging is multi-parametric (mpMRI). mpMRI combines multiple MRI techniques and scans that work together to check for things like cancer. Physicians may see a reduction in the number of necessary biopsies due to the introduction of mpMRI. The process includes taking conventional and diffusion weighted (DW) images while using an acceleration technique. Certain programs can help expedite the progress by helping obtain measurements that can be checked against the radiologist's measurements.

Another imaging technique that has gained some favor in the MRI world for prostate imaging is one that is interleaved. Interleaved methods acquire several slices (or images) at the same time, within the same repetition time interval.5 This is also sometimes referred to as slice-interleaved or slice-multiplexed acquisition. Like mpMRI, this technique may obtain DW images. Interleaving DWI can lead to high spatial resolution, signal to noise ratio and spatial fidelity.5

Both multi-parametric MRI and interleaved imaging can help to shorten the amount of time in the scanner due to the acceleration techniques that can be used. The reduction in time may help patients be more comfortable, which is important when imaging something that can have such an impact on men's health. The attempts to increase awareness about prostate health may cause an influx of patients needing these exams, which would be a great first step in helping men to understand what is going on.

References

1. "Prostate Problems." NIA.NIH.gov. Web. 4 June 2019. <https://www.nia.nih.gov/health/prostate-problems>.

2. Mayo Clinic Staff. "Benign prostatic hyperplasia (BPH)." MayoClinic.org. 2 March 2019. Web. 4 June 2019. <https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087>.

3. Mayo Clinic Staff. "Prostatitis." MayoClinic.org. 16 May 2018. Web. 4 June 2019. <https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766>.

4. Fatih Kantarci. "Multi-parametric imaging in shorter scan times for prostate cancer imaging." SIGNA Pulse. Autumn 2018. Web. 4 June 2019. <http://www.gesignapulse.com/signapulse/autumn_2018/MobilePagedArticle.action?articleId=1444524#articleId1444524>.

5. Nan-kuei Chen, et al. "A robust multi-shot scan strategy for high-resolution diffusion weighted MRI enabled multiplexed sensitivity-encoding (MUSE)." Neuroimage. 15 May 2013; 72: 41-47. Web. 30 May 2019. doi: 10.1016/j.neuroimage.2013.01.038.