الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Diagnosis of prostate cancer depend on elevated serum PSA
level and confirmed with trans-rectal US–guided biopsy using
sextant samples obtained from the peripheral zone (Yacoub et al,
2012).
Multiple limitation factors for this diagnostic paradigm include:
1. low specificity of serum PSA for the detection of cancer
prostate and may leads to unnecessary biopsy.
2. Many prostatic condition (eg, benign prostatic
hyperplasia, acute or chronic prostatitis) elevate serum
PSA value.
3. The cut of value for serum PSA level is > 4 ng/mL shows
major limitation as Clinically significant cancer could be
present even with a lower PSA value (Yacoub et al,
2012).
4. TR US guided biopsy which usually does not allow the
direct visualization and targeting of abnormal regions of
the prostate, yet it can detect cancerous lesions in some
cases. So, TRUS–guided biopsy has a low sensitivity
(range, 39%–52%), yet with specificity of approximately
80% though, repeated biopsies were needed (Yacoub et
al, 2012).
The cancer detection rate falls from 22%– 38% at the initial
biopsy to 10%–17% at the second biopsy and 5%–15% at the third
biopsy (Yacoub et al, 2012).
Functional MR imaging techniques combined with
conventional imaging had provided improved cancer detection and
localization, as well as information regarding the aggressiveness,
volume, and staging of cancers for individualized therapy.
we proved that mp-MRI has sensitivity, specificity, validity,
positive predictive value and negative predictive values of 100%
compared to biopsy-proven pathological results which is only
82.1% sensitivity, specificity 100%, validity of 84.8% and negative
predictive value 50% yet 100% positive predictive value.
We prove that the mean ADC for areas with negative biopsy
findings is > 1.2 x 10-3 mm2/sec2 in PZ and mean ADC values in
tumors with Gleason score 3+3 is 0.910 0 +/_ 0.18367 x 10-3
mm2/sec2 ranging from (o.63-1.2 x 10-3 mm2/sec2).
The mean ADC values in Gleason score 3+4 is 0.7829 +/_
0.10095 x 10-3 mm2/sec2, Gleason 4+3 is 0.7829+/_0.11814 x
10-3 mm2/sec2, Gleason 4+4 is 0.5311 +/_ 0.09293 x 10-3
mm2/sec2 and Gleason 4+5 is 0.3883 +/_ 0.07333 x 10-3
mm2/sec2. Showing the following ranges respectively (0.70 -
0.97), (0.61 - 0.96), ( 0.41 - 0.72) and (0.30 - 0.50).
The significance between different Gleason scores are as
following 3+3 to 4+3 is 0.586, 3+3 to 3+4 is 0.047, 3+3 to 4+4 is
0.0001, 3+3 to 4+5 is 0.0001, 3+4 to 4+3 is 0.173, 3+4 or 4+3 to
4+4 and 4+5 are 0.0001 and 4+4 to 4+5 is 0.0001.
They show overall significance between different Gleason
scores 0.0001 (The mean difference is significant at the 0.05 level
or less).
Conclusion:
mp-MRI has high sensitivity and specificity in diagnosis of
prostate cancer specially in early stages which are missed by transrectal
US guided biopsy and showing high P value in correlating
ADC values to Gleason score.