Multiparametric MRI - local staging of prostate cancer and beyond

Abstract

Background Accurate local staging is critical for treatment planning and prognosis in patients with prostate cancer (PCa). The primary aim is to differentiate between organ-confined and locally advanced disease with the latter carrying a worse clinical prognosis. Multiparametric MRI (mpMRI) is the imaging modality of choice for the local staging of PCa and has an incremental value in assessing pelvic nodal disease and bone involvement. It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease. MRI has a high specificity for diagnosing extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node (LN) metastases, however, sensitivity remains poor. As a result, extended pelvic LN dissection remains the gold standard for assessing pelvic nodal involvement, and there has been recent progress in developing advanced imaging techniques for more distal staging. Conclusions T2W-weighted imaging is the cornerstone for local staging of PCa. Imaging at 3T and incorporating both diffusion weighted and dynamic contrast enhanced imaging can further increase accuracy. “Next generation” imaging including whole body MRI and PET-MRI imaging using prostate specific membrane antigen (68Ga-PSMA), has shown promising for assessment of LN and bone involvement as compared to the traditional work-up using bone scintigraphy and body CT.

MRI features of the normal prostatic peripheral zone: the relationship between age and signal heterogeneity on T2WI, DWI, and DCE sequences

“…Two recent studies in men undergoing prebiopsy prostate MRI highlight this potential issue, with systematic biopsy showing a higher detection rate over targeted biopsy in men < 50 years [29] and mpMRI having a significantly lower sensitivity for clinically significant PCa in patients < 50 years old (49%) compared to men aged over 55 (73%) [30]. Beyond lesion detection, the ability to accurately stage the gland may also be compromised, as lesion-capsular contact is a key criterion, and may be more challenging to estimate in the context of diffuse background change [31][32][33][34]. The scoring system we propose may thus be a valuable addition to everyday clinical practice.…”

MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance

“…In 8 cases, PRECISE score 5 triggered a direct switch to treatment. One of 8 patients underwent radical prostatectomy where T3a was confirmed at final pathology, whereas 7 of 8 patients were treated by radiotherapy; thus, pathological progression was not definitely confirmed; however, the specificity of MRI for T staging is known to be high [ 31 ]. In addition, prospective assignment of PRECISE scores did not allow multi-reader approach for image interpretation and evaluation of inter-reader agreement; however, the main aim of our study was to test the scoring system against real-world outcomes.…”

Magnetic resonance imaging improves the prediction of tumor staging in localized prostate cancer

“…Using 3 Tesla mpMRI, an increase in sensitivity for the detection of a T3 stage has been reported mostly using a surface coil [ 14 ]. Currently, measurable or visible EPE and/or SVI are used as predictors for T stage determination on MRI [ 16 ]. In addition, the probability of EPE increases with larger capsule contact length (LCC) [ 17 ].…”