Evaluating the Role of mpMRI in Prostate Cancer Assessment

ABSTRACT

Prostate cancer is the most common malignancy among American men. The role of multi-parametric MRI has recently gained more importance in detection of prostate cancer, its targeted biopsy, and focal therapy guidance. In this review, uses of multi-parametric MRI in prostate cancer assessment and treatment are discussed.

KEYWORDS:

• prostate cancer
• MRI
• biopsy
• focal therapy
• PIRADS

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• T2W MRI, DW-MRI (including ADC maps and high b-value DW-MRI), and DCE-MRI are key pulse sequences of mpMRI.

• Use of endorectal coil provides the best possible scan quality, but involves patient discomfort and increased cost. Studies obtained at 3T with or without the ERC produce similar results.

• PI-RADS v2 guidelines lay out the recommended technical parameters for obtaining mpMRI and guidelines for interpretation and scoring of each pulse sequence.

• Including mpMRI information in guiding biopsies (cognitive, in bore, TRUS/MRI fusion guided) improves the biopsy yield compared to systematic TRUS-only-guided biopsies.

• Although a relatively new approach, combined with the use of MRI guidance, focal treatment of PCa is possible with low risk of altering the patients’ quality of life.

• Use of mpMRI in active surveillance is a new approach, but it has been shown to be effective in monitoring patients with low-risk PCa. Further evidence with larger scale studies is needed for this use.

• Early detection of local residual/recurrent disease focus in patients with biochemical recurrence after definitive therapy (surgery or radiotherapy) is critical and difficult. mpMRI has promising results in localizing disease foci in this patient population.

• When used in conjunction with the traditional detection and monitoring methods, mpMRI has proven to be a successful technique for assessing PCa.