MRI in prostate cancer diagnosis, surgical or radiation treatment, focal therapy, active surveillance and follow-up

Serum prostate-specific antigen, digital rectal examination and transrectal ultrasound, supplemented with biopsy, are conventionally used for the screening, diagnosis, staging and surveillance of prostate cancer (PCa). However, their sensitivity and specificity are limited with diagnosis of clinically insignificant cancer and a potential risk of overtreatment as a result. Multiparametric MRI combines anatomical and functional pulse sequences, including diffusion-weighted imaging and dynamic contrast-enhanced MRI, and has evolved out of its limited role in PCa staging. The ability to visualise the prostate accurately and to detect or exclude clinically significant PCa makes multiparametric MRI a great tool to improve the diagnosis, staging, treatment planning and follow-up of patients with PCa. Multiparametric MRI can rule out clinically significant PCa and therefore has the potential to reduce the need for biopsies or to determine whether active surveillance or immediate treatment is appropriate.

(BELG J MED ONCOL 2018;12(7):313–318)