Angiogenesis imaging in the management of prostate cancer

Angiogenesis is an integral part of benign prostatic hyperplasia, is associated with prostatic intraepithelial neoplasia and is a key factor in the growth and metastasis of prostate cancer. This review focuses on ultrasound and dynamic MRI in the evaluation of prostate cancer angiogenesis, and compares these techniques to functional CT and hydrogen magnetic resonance spectroscopic imaging. Image-based evaluation of angiogenesis in the prostate has established clinical roles in lesion detection, tumor staging and the detection of suspected tumor recurrence. One limitation of all these imaging techniques, however, is inadequate lesion characterization, particularly in differentiating prostatitis from cancer in the peripheral zone of the prostate, and in distinguishing between benign prostatic hyperplasia and central-gland tumors. Ultimately, local availability, expertise and the need to minimize patients' radiation burden will influence which technique is used in prostatic evaluations.