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Fig. 3. Two stage T3a prostate cancers (extracapsular invasion), T2-weighted axial MR image. a Large cancer is replacing about two thirds of the left prostate (T). There is extracapsular extension at the site of the neurovascular bundle (arrows). Clear asymmetry of neurovascular bundles. Normal neurovascular bundle on right. b Large tumor (T) in right peripheral zone. There is bulging and extracapsular tumor spread (arrows)

Fig. 3. Two stage T3a prostate cancers (extracapsular invasion), T2-weighted axial MR image. a Large cancer is replacing about two thirds of the left prostate (T). There is extracapsular extension at the site of the neurovascular bundle (arrows). Clear asymmetry of neurovascular bundles. Normal neurovascular bundle on right. b Large tumor (T) in right peripheral zone. There is bulging and extracapsular tumor spread (arrows)

a problem using the ERC, which has an accuracy range between 81-96% [21, 23, 24, 26]. T1- and T2-weighted images should be acquired at least two weeks after the prostate biopsy, as hemorrhage decreases staging accuracy [28].

Beside its role in staging, MR imaging is useful in reducing the number of false negative prostate biopsies in patients with elevated PSA and repeated negative (TRUS-guided) biopsies. With MR imaging, prostate cancer can be detected and then a MR-directed biopsy can be performed. Using MR imaging as a method to detect cancer lesions in a group of 36 patients with negative biopsies and elevated PSA values, an accuracy of 78%, a positive predictive value of 74%, and a negative predictive value of 84% was achieved [29].

In summary, the role of MR imaging in local staging is not yet clearly defined, however, it is considered to be

Fig. 4. Stage T3b prostate cancer (seminal vesicle infiltration). On sagittal (a) and coronal (b) T2-weighted images, low SI area is present representing tumor with seminal vesicle invasion (arrows)

cost-effective in a selected group of patients. SVI can be detected with high accuracy, which is an advantage in comparison with TRUS alone.

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