Application of Advanced Imaging to Prostate Cancer Diagnosis and Management: A Narrative Review of Current Practice and Unanswered Questions

Abstract

Major advances in prostate cancer diagnosis, staging, and management have occurred over the past decade, largely due to our improved understanding of the technical aspects and clinical applications of advanced imaging, specifically magnetic resonance imaging (MRI) and prostate-cancer-specific positron emission tomography (PET). Herein, we review the established utility of these important and exciting technologies, as well as areas of controversy and uncertainty that remain important areas for future study. There is strong evidence supporting the utility of MRI in guiding initial biopsy and assessing local disease. There is debate, however, regarding how to best use the imaging modality in risk stratification, treatment planning, and assessment of biochemical failure. Prostate-cancer-specific PET is a relatively new technology that provides great value to the evaluation of newly diagnosed, treated, and recurrent prostate cancer. However, its ideal use in treatment decision making, staging, recurrence detection, and surveillance necessitates further research. Continued study of both imaging modalities will allow for an improved understanding of their best utilization in improving cancer care.

Editorial: PET/CT and MRI in prostate cancer

“…However, the extent of this prognostic improvement and its practical significance and implications remain to be thoroughly evaluated. MRI of the prostate has been, however, recommended as the initial diagnostic test for men presenting with suspected PCa, with a negative MRI enabling safe avoidance of biopsy and a positive result enabling MRI-directed sampling of lesions (7). Evidence supports the role of the MRI-directed pathway for PCa diagnosis, with improved performance over the previous clinical standard of systematic TRUS needle biopsy of the prostate.…”