MRI in early detection of prostate cancer

Abstract

Purpose of review: The use of magnetic resonance imaging (MRI) in the early detection of prostate cancer (PCa) is increasing rapidly. In the last couple of years, there have been a number of key publications which have led to its adoption in the UK and European guidelines. Recent findings: PROMIS showed that standard biopsy missed up to half of clinically significant disease, compared to 5mm template mapping biopsy. Three studies then compared the standard transrectal ultrasound (TRUS) pathway to an MRI+/-targeted biopsy pathway. These showed that MRI-targeted biopsies detect more clinically significant disease and reduce overdetection of indolent disease whilst allowing between one third to one half of men to avoid an immediate biopsy. Cost effectiveness data show that using MRI to determine who gets a biopsy and how that biopsy is done is a cost-neutral approach when men at lowest risk do not undergo biopsy. Summary: Prostate MRI is a useful and cost-effective tool for early detection of PCa which minimises the impact of overdetection and overtreatment whilst maximising the detection of PCa which could benefit from treatment. The next challenge is to ensure that centres offering MRI are able to offer high quality MRI acquisition and reporting.

The impact of pre‐biopsy MRI and additional testing on prostate cancer screening outcomes: A rapid review

“…3,4 The use of magnetic resonance imaging (MRI) has subsequently emerged as a safe and viable tool to detect cancerous lesions within the prostate. 3,5 MRI images can be taken using two key forms of MRI multiparametric (mp) MRI, using T2-weighted anatomical imaging, diffusion-weighted MRI, and dynamic contrast-enhanced (DCE) MRI and biparametric (bp) MRI, which does not require DCE. Images acquired through bpMRI and mpMRI can be evaluated using diagnostic scoring systems such as Likert and Prostate Imaging-Reporting and Data System (PI-RADS) v2.1, to diagnose clinically significant (≥3 + 4; also defined as Gleason ≥7 disease-Gleason grade group 2 or above) and clinically insignificant prostate cancer lesions, that is, 3 + 3; also defined as Gleason 6-Gleason grade group 1.…”

“…The use of magnetic resonance imaging (MRI) has subsequently emerged as a safe and viable tool to detect cancerous lesions within the prostate 3,5 . MRI images can be taken using two key forms of MRI multiparametric (mp) MRI, using T2‐weighted anatomical imaging, diffusion‐weighted MRI, and dynamic contrast‐enhanced (DCE) MRI and biparametric (bp) MRI, which does not require DCE.…”

Patient‐reported functional outcomes and oncological control after primary focal cryotherapy for clinically significant prostate cancer: A Phase II mandatory biopsy‐monitored study

“…Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsies now allow aggressive prostate cancer to be detected early at small volumes. 7,8 This has rekindled interest in focal therapy to target only the part of the gland with aggressive cancer while sparing the normal part of the gland, thereby reducing collateral damage to the cavernosal nerves, and continence mechanisms and preserving the quality of life. 9 However, there do remain untested assumptions.…”

Viabilidad y seguridad de la biopsia prostática transperineal en la era de fusión de imágenes por resonancia magnética cognitiva/ultrasonido en la detección del cáncer

“…La combinación de imágenes anatómicas en T1, T2, funcionales, ponderadas por difusión proporciona una buena sensibilidad para la detección y localización de tumores con una puntuación de Gleason ≥7 [11,12] . Permitiéndonos diagnosticar pacientes con CaP-cs y reducir el número de diagnósticos de CaP-ci; reduciendo el número de tratamientos innecesarios [13][14][15][16][17][18] . La Biopsia Transperineal de Próstata por Fusión Cognitiva por Resonancia Magnética y Ultrasonido (BTPPFC-RM/US) permite obtener muestras en áreas de la próstata que son difíciles y frecuentemente imposibles de obtener por el abordaje transrectal, principalmente de la región anterior de la próstata [14,19] .…”