Multiparametric magnetic resonance imaging of prostate cancer.

Dear Sir,

We read the interesting article by Hedgire et al., titled “Multiparametric magnetic resonance imaging of prostate cancer,”[1] which was published in the August 2012 issue of the journal. The study included fairly important information which was very useful for us. However, we would like to make a few contributions.

Mucinous-type lesions are rare adenocarcinomas of the prostate gland and tend to show hyperintensity on T2-weighted images. Thus, mucinous tumors may be missed in T2-weighted images. Likewise, mucinous lesions may be missed in diffusion-weighted imaging (DWI) since high apparent diffusion coefficient (ADC) values may be obtained for mucinous tumors.[2] We believe that MR spectroscopy may provide more realistic results in determining these lesions.

In our experience of prostate MRI and histopathologic results, we did not observe any prostate cancer focus at the hematoma site in the peripheral zone on prostate MR examination obtained 2-3 weeks after prostate biopsies. However, we detected cancer focus at the non-hemorrhagic sites in the peripheral zone. In our opinion, the reason for this is that hematoma cannot dissect the tumor composed of tightly packed cells. Therefore, we recommend that non-hemorrhagic sites in the peripheral zone on T1-weighted images should especially be evaluated for the presence of tumor focus on the other imaging sequences.