Multi-parametric magnetic resonance imaging as a management decision tool

Abstract

The ability to image the prostate accurately and better characterize cancerous lesions makes multiparametric magnetic resonance imaging (mpMRI) an invaluable tool to improve management of localized prostate cancer (PCa). Improved risk stratification is warranted given the evidence of significant overtreatment of indolent PCa. mpMRI can more accurately rule out clinically significant PCa in men deciding between surveillance and definitive treatment to reduce overtreatment. mpMRI improves detection of clinically significant PCa, which helps minimize sampling error, a major limitation of the traditional diagnostic paradigm. Aside from helping determine candidacy for initial surveillance vs. treatment, mpMRI is a useful tool for following men on active surveillance (AS) with the potential to reduce the need for serial biopsies. When definitive treatment is warranted, mpMRI can be used to determine the local extent of disease. This provides information that is useful in the treatment decision, counseling about outcomes, and surgical planning. While mpMRI is a significant step forward in PCa management, it is necessary to understand its limitations. mpMRI and MRI-guided fusion biopsy techniques still do not detect all clinically significant tumors. The utility of current mpMRI techniques is limited by the multifocal nature of PCa with poor detection of non-index lesions, inaccurate estimation of tumor size and geometry, and the need for interpretation by specialized radiologists. The role of mpMRI will continue to expand as improvements in technology and experience help overcome these limitations.

Prediction of biochemical recurrence in prostate cancer patients who underwent prostatectomy using routine clinical prostate multiparametric MRI and decipher genomic score

“…Multiparametric prostate magnetic resonance imaging (mpMRI) is commonly used in men with diagnosed PCa to improve PCa risk stratification. 7,8 Furthermore, multiple groups have explored the potential of mpMRI for predicting BCR in patients who underwent RALP or radiotherapy. [9][10][11] Multiple commercially available molecular tests exist that can be performed using biopsies core or prostatectomy specimens, such the Decipher Genomic Classifier.…”

“…Multiparametric prostate magnetic resonance imaging (mpMRI) is commonly used in men with diagnosed PCa to improve PCa risk stratification . Furthermore, multiple groups have explored the potential of mpMRI for predicting BCR in patients who underwent RALP or radiotherapy .…”

Multiparametric magnetic resonance imaging: Overview of the technique, clinical applications in prostate biopsy and future directions

“…Renewed clinical interest occurred with increased magnet quality from 0.3T-0.5T to 1.5T and even up to 3T, with further incremental gains from endorectal coil (ERC) technique and multiphasic sequencing. [12][13][14] Multiparametric MRI (mpMRI) can be briefly summarized as a method of trying to obtain an ideal three-dimensional (3D) prostate image by combining T2-weighted (T2WI), diffusion weighted (DWI), dynamic contrast enhanced (DCEI) and, if desired, MR spectroscopy (MRSI) images. Although many centers have developed their own MRI interpretation system using some of these sections, there is no standard defined combination yet.…”

Impact of preoperative prostate magnetic resonance imaging on the surgical management of high-risk prostate cancer

“…Current loco-regional staging with computed tomography (CT) scans and digital rectal exams are inadequate for detecting EPE and SVI [7,8]. mpMRI can be used to determine the extent of local disease in prostate cancer patients, but has not been widely adopted for preoperative surgical planning [8][9][10].…”