Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Abstract

Prostate cancer is a major public health burden throughout the world. The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and the slow natural progression and biological heterogeneity of the disease, has made its management a complex and controversial issue. There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits. There are a number of clinical parameters and clinical nomograms to help with the choice of treatment. Magnetic resonance imaging (MRI) is a technique which makes safer, more individualized therapies possible due to high spatial resolution, superior contrast resolution, multiplanar capability, and a large field of view. Other MRI techniques such as MR spectroscopic imaging, dynamic contrast-enhanced MRI or perfusion MRI, and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry, Brownian motion of water molecules, and capillary wall permeability, respectively. This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, some future prospects for MRI in prostate cancer management are given.

Prostate cancer - the role of magnetic resonance imaging

“…Radical prostatectomy in organ defined prostate cancer seems to have excellent prognosis, as more than 90% (ref. 2 ) are free from recurrence at 5 years. Nomogram prediction of organ defined prostate cancer is high with under the receiver operating characteristic (ROC) curve ranging from 0.79 to 0.82.…”

“…2 ) and sensitivity 46-96% (ref. 2 ). A prospective study of 27 patients reported that MRI had significantly higher standardized canonical discriminant function coefficient than Partin tables in predicting extracapsular extension of PC (ref.…”

“…The downstaging resulting from prostatic serum antigen (PSA) screening has been accompanied by an unfortunate trend of over detection and over treatment of biologically indolent (low-grade, clinically insignificant) disease. Primary therapies with curative intent (surgery or radiation) provide excellent long-term cancer control, but accompanied by a risk of treatment -related morbidity 2 . The real challenge for physicians is to differentiate patients with advanced cancer and increased risk of morbidity/ mortality from those who will not require immediate or possibly delayed and therapeutic intervention 2 .…”

“…Primary therapies with curative intent (surgery or radiation) provide excellent long-term cancer control, but accompanied by a risk of treatment -related morbidity 2 . The real challenge for physicians is to differentiate patients with advanced cancer and increased risk of morbidity/ mortality from those who will not require immediate or possibly delayed and therapeutic intervention 2 . There are a number of clinical parameters and clinical nomograms to help with the choice of treatment.…”

“…The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and slow natural progression and biological heterogeneity of the disease has made its management a complex and controversial issue. Prostate tumours have a slow growth rate and allow for prolonged survival 2 . The downstaging resulting from prostatic serum antigen (PSA) screening has been accompanied by an unfortunate trend of over detection and over treatment of biologically indolent (low-grade, clinically insignificant) disease.…”