SYNOPSIS OF DISSERTATION

I, Dr. INGOLE SARANG MANOHARRAO have registered for Primary DNB in Radio-diagnosis at SAIFEE HOSPITAL, Mumbai from March 2014 to March 2017.My topic for thesis is ROLE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING(MRI) IN PROSTATE CANCER under the guidance of Dr. RAJEEV MEHTA; M.D, D.M.R.E, PROF. & H.O.D. IMAGING, SAIFEE HOSPITAL, MUMBAI.

Herewith attaching the thesis protocol for approval.

TITLE: ROLE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING (MRI) IN PROSTATE CANCERNAME: DR. INGOLE SARANG MANOHARRAOSUBJECT: DNB RADIODIAGNOSIS, PRIMARYJOINING: 31st MARCH 2014 INSTITUTE: SAIFEE HOSPITAL, MUMBAI.TRAININGDURATION: MARCH 2014 TO MARCH 2017.

DNB GUIDE : DR.RAJEEV MEHTA M.D, D.M.R.E PROF. & HEAD OF IMAGING, SAIFEE HOSPITAL MUMBAI

1.1 INTRODUCTION

Prostate cancer is the most commonly diagnosed malignancy in men, with almost one-fourth of males diagnosed with malignancy having cancer of the prostate. In India prostate cancer has an incidence rate of 3.9 per 100,000 men and is responsible for 9% of all cancer-related mortality.1 Prostate cancer is evaluated by a combination of clinical and biopsy data, including the clinical stage [based on the digital rectal examination (DRE)], serum prostate-specific antigen (PSA) level and the Gleason score at biopsy.Today the detection of prostate cancer typically begins with prostate-specific-antigen (PSA) levels and/or digital rectal examination (DRE). If either of these are abnormal, a transrectal ultrasound (TRUS) followed by guided biopsy is often the next step. However, there are some shortcomings with this modality, such as:1.Dependence on the skill and experience of the operator.2.Limited field of view.3.Less accurate assessment of spread and hence staging. The false negative rate of TRUS-guided biopsies is estimated to be between 15% and 34%2. Also problems arise when, despite a high degree of suspicion for cancer (based upon PSA/DRE), a pathological diagnosis cannot be confirmed. The superior soft tissue resolution, multiplanar imaging capability, and technical refinements have established MRI as the most accurate modality for the detection and staging of prostate cancer. MRI is now been widely used as a staging tool after a diagnosis is made through a transrectal biopsy.3 Traditional prostate MR imaging has been based on morphologic imaging with standard T1-weighted and T2-weighted sequences, which has limited accuracy. Recent advances include additional functional and physiologic MR imaging techniques (diffusion weighted imaging, MR spectroscopy, and dynamic contrast enhanced imaging), which allow extension of the obtainable information beyond anatomic assessment. In multiparametric imaging, the anatomical and functional information is integrated. Thus multi-parametric MR imaging provides the highest accuracy in diagnosis and staging of prostate cancer4.

1.2 REVIEW OF LITERATUREHistorically, prostate cancer screening is based on assessment of the level of PSA elevation and results of digital rectal examination (DRE). Both markers have suboptimal accuracy for the diagnosis of prostate cancer. DRE is affected by interexaminer variability, irrespective of experience, and is limited to assessment of peripheral zone tumors. However DRE still remains a fundamental part of screening owing to its being part of the clinical examination without additional cost, its ubiquitous availability, and its ability to allow identification of the tumor in 14% of men with prostate cancer according to Okotie OT et al(2007)5.PSA screening was recognized as a screening tool in 1991. Its introduction has led to a significant decrease in stage at diagnosis and to detection of tumors of very small volume (often 4ngm/ml, hard prostate in digital rectal examination, and suspicious area at transrectal US) or TRUS biopsy proven cases of prostate cancer.Exclusion Criteria: All patients having cardiac pacemakers, prosthetic heart valves, cochlear implants or any metallic implants. Claustrophobic patients Patients who are not willing for the study. In addition, patients having high S.Creatinine levels (>1.5mg/dl) and low eGFR (