The future direction of imaging in prostate cancer: MRI with or without contrast injection

Abstract

Background: Multiparametric MRI (mpMRI) is the "state of the art" management tool for patients with suspicion of prostate cancer (PCa). The role of non-contrast MRI is investigated to move toward a more personalized, less invasive, and highly costeffective PCa diagnostic workup.Objective: To perform a non-systematic review of the existing literature to highlight strength and flaws of performing non-contrast MRI, and to provide a critical overview of the international scientific production on the topic. Materials and Methods:Online databases (Medline, PubMed, and Web of Science) were searched for original articles, systematic review and meta-analysis, and expert opinion papers.Results: Several investigations have shown comparable diagnostic accuracy of biparametric (bpMRI) and mpMRI for the detection of PCa. The advantage of abandoning contrast-enhanced sequences improves operational logistics, lowering costs, acquisition time, and side effects. The main limitations of bpMRI are that most studies comparing non-contrast with contrast MRI come from centers with high expertise that might not be reproducible in the general community setting; besides, reduced protocols might be insufficient for estimation of the intra-and extra-prostatic extension and regional disease. The mentioned observations suggest that low-quality mpMRI for the general population might represent the main shortage to overcome.Discussion: Non-contrast MRI future trends are likely represented by PCa screening and the application of artificial intelligence (AI) tools. PCa screening is still a controversial topic; bpMRI has become one of the most promising diagnostic applications, as it is a more sensitive test for PCa early detection, compared to serum PSA level test. Also, AI applications and radiomic have been the object of several studies investigating PCa detection using bpMRI, showing encouraging results. Conclusion:Today, the accessibility to MRI for early detection of PCa is a priority.Results from prospective, multicenter, multireader, and paired validation studies are needed to provide evidence supporting its role in the clinical practice.

MRI Based Radiomics Compared With the PI-RADS V2.1 in the Prediction of Clinically Significant Prostate Cancer: Biparametric vs Multiparametric MRI

“…( 17 ) reported an overall csPCa detection rate of 16–21% based on 665 PI-RADS 3 lesions, consistent with our results. Nevertheless, it is still recommended to use DCE imaging as a supplementary sequence for indeterminate lesions, small cancers, lesions in challenging locations and in previously treated prostates ( 18 ).…”

“…Schoots et al (17) reported an overall csPCa detection rate of 16-21% based on 665 PI-RADS 3 lesions, consistent with our results. Nevertheless, it is still recommended to use DCE imaging as a supplementary sequence for indeterminate lesions, small cancers, lesions in challenging locations and in previously treated prostates (18). Although the use of the PI-RADS has widened the application value of prostate MRI, it must be noted that the inter-reader variability remains an unsolved problem.…”

Imaging andrology of the future: Where functional imaging embraces the clinic

“…The shift‐in‐paradigm mentioned above has revealed that a significant number of such lesions are benign 9 . In a similar manner, this has occurred with multiparametric prostate‐MRI, which has significantly changed the indication and need for prostate‐biopsies 10 …”

“…9 In a similar manner, this has occurred with multiparametric prostate-MRI, which has significantly changed the indication and need for prostate-biopsies. 10 This Special Issue of Andrology brings together excellent research on this topic. The call for papers was launched in 2020 and was characterized by a fast-track phase, gathering manuscripts submitted up to March 30, 2021, followed by rigorous review times, for both authors and reviewers.…”

“…Whether the slight loss in accuracy can be overcome by a more personalized protocol, less invasive, and costeffective diagnostic workup remains to be validated. 10 All these topics are rapidly changing, and the field is broadening: the future we foresee for andrological imaging is bright and promising.…”