Role of multiparametric magnetic resonance imaging in early detection of prostate cancer

Abstract

Most prostate cancers (PC) are currently found on the basis of an elevated PSA, although this biomarker has only moderate accuracy. Histological confirmation is traditionally obtained by random transrectal ultrasound guided biopsy, but this approach may underestimate PC. It is generally accepted that a clinically significant PC requires treatment, but in case of an non-significant PC, deferment of treatment and inclusion in an active surveillance program is a valid option. The implementation of multiparametric magnetic resonance imaging (mpMRI) into a screening program may reduce the risk of overdetection of non-significant PC and improve the early detection of clinically significant PC. A mpMRI consists of T2-weighted images supplemented with diffusion-weighted imaging, dynamic contrast enhanced imaging, and/or magnetic resonance spectroscopic imaging and is preferably performed and reported according to the uniform quality standards of the Prostate Imaging Reporting and Data System (PIRADS). International guidelines currently recommend mpMRI in patients with persistently rising PSA and previous negative biopsies, but mpMRI may also be used before first biopsy to improve the biopsy yield by targeting suspicious lesions or to assist in the selection of low-risk patients in whom consideration could be given for surveillance.Teaching Points• MpMRI may be used to detect or exclude significant prostate cancer.• MpMRI can guide targeted rebiopsy in patients with previous negative biopsies.• In patients with negative mpMRI consideration could be given for surveillance.• MpMRI may add valuable information for the optimal treatment selection.

The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer

“…However, further analysis of the Gleason score 7 cases assigned a normal mpMRI revealed that 84% were associated with a Gleason score of 3+4 (rather than 4+3), which according to University College London (UCL) definition 1 is considered to be 'clinically insignificant cancer' [17]. The definition of csPCa varies across centres and when defined by Gleason score, ranges from any pattern ≥4 (UCL definition 2) to a primary pattern ≥4 (UCL definition 1) [9,17,18]. Re-assessment of our present data using UCL definition 1 results in the number of csPCa assigned a normal mpMRI dropping to 2.9% in the present series.…”

Prostate-Specific Membrane Antigen Ligands for Imaging and Therapy

“…Imaging has increasingly been used over the last 2 decades to improve initial staging and help localize tumor deposits in recurrent disease. For instance, multiparametric MRI (mpMRI) has been shown to be effective in detecting or ruling out clinically significant disease, with a high negative predictive value of greater than 90% in various studies, and it can guide targeted biopsy (3,4). Primary staging by bone scanning and cross-sectional imaging, as recommended for high-risk disease, is hampered by a high percentage of lymph node (LN) metastases in nonenlarged LNs (pooled sensitivity, 39%-42%) (5,6).…”

Score 3 prostate lesions: a gray zone for PI-RADS v2

“…[5][6][7] The main objective is the improvement of the biopsy yield by targeting suspicious lesions and minimizing the risk of unnecessary diagnosis of insignificant PCa. [8][9][10][11][12] PI-RADS v2: advantages and limits Recent Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), is worldwide employed to improve detection, localization, characterization and stratification in patients with suspected PCa and to communicate the conclusive results of the imaging modality to the referring clinician. [13] PI-RADS v2 allows an assessment of categories -ranging from 1 to 5 for each lesion -providing clinical guidelines for multiparametric MRI (mpMRI).…”