Multiparametric MRI in the management of prostate cancer: an update—a narrative review

Abstract

The growing interest in multiparametric MRI is leading to important changes in the diagnostic process of prostate cancer. MRI-targeted biopsy is likely to become a standard for the diagnosis of prostate cancer in the next years. Despite it is well known that MRI has no role as a staging technique, it is clear that multiparametric MRI may be of help in active surveillance protocols. Noteworthy, MRI in active surveillance is not recommended, but a proper understanding of its potential may be of help in achieving the goals of a delayed treatment strategy. Moreover, the development of minimally invasive techniques, like laparoscopic and robotic surgery, has led to greater expectations as regard to the functional outcomes of radical prostatectomy. Multiparametric MRI may play a role in planning surgical strategies, with the aim to provide the highest oncologic outcome with a minimal impact on the quality of life. We maintain that a proper anatomic knowledge of prostate lesions may allow the surgeon to achieve a better result in planning as well as in performing surgery and help the surgeon and the patient engage in a shared decision in planning a more effective strategy for prostate cancer control and treatment. This review highlights the advantages and the limitations of multiparametric MRI in prostate cancer diagnosis, in active surveillance and in planning surgery.

Autonomous Tumor Signature Extraction Applied to Spatially Registered Bi-Parametric MRI to Predict Prostate Tumor Aggressiveness: A Pilot Study

“…Another approach, needle biopsy, can easily under-sample the tumor due to needle misplacement and can possibly lead to side effects such as infections or hemorrhage [9][10][11][12]. To alleviate undersampling and side-effect issues, MRI [13,14] and multi-parametric MRI (MP-MRI) [15][16][17] have been employed more recently to non-invasively assess prostate cancer. To reduce patient discomfort, possible side effects and increase patient flow through the clinic, biparametric MRI-unlike multi-parametric MRI-does not require injection of contrast material and has been investigated as a simpler alternative diagnostic approach [18][19][20][21].…”

Technical note: hydrogel‐based mimics of prostate cancer with matched relaxation, diffusion and kurtosis for validating multi‐parametric MRI

“…Multi‐parametric (mp) MRI is widely used in clinical practice 1–3 for disease detection and evaluation based on the soft‐tissue contrast changes due to altered water magnetization relaxation 4 and diffusion 5 . Recent developments suggest added value in sensitivity and specificity of the quantitative mpMRI protocols, 6,7 particularly for prostate cancer risk stratification 8–10 .…”