Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
Prostate cancer is the most common malignancy in men in Europe, North America and in some African states, and second in causes of cancer death among men in western Europe and North America. Early diagnosis in an asymptomatic stage is essential because the most favorable outcome that can be achieved is associated with small and organ-confined cancer. Current approaches for early detection of prostate cancer are controversially discussed because the disease is characterized by a high incidence rate, but relatively low morbidity, the availability of only limited prognostic markers and still marked therapy-related morbidity. Conventional T2-weighted magnetic resonance imaging (MRI) plays no role in early detection as small tumor foci cannot be delineated. If there is a clinical suspicion for prostate cancer, however, multiparametric MRI is currently the most accurate method for detecting and characterizing suspicious lesions in the prostate. It has been shown in patients with at least one negative transrectal ultrasonography (TRUS)-guided prostate biopsy that the detection rate of prostate cancer is significantly higher by MRI-guided compared with repeat TRUS-guided biopsy. Of particular importance is the potential to identify the so-called index lesion, the therapy leading tumor area with the highest biologic aggressiveness, that can confidently be confirmed histologically through MRI guidance. The information from multiparametric MRI increases the accuracy of prostate biopsy and can serve as a biomarker for follow-up during active surveillance. The method may contribute considerably to the urgently required differentiation between clinically significant and clinically insignificant prostate cancers.
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Reference: Cancer Imaging. 2011 Oct 3;11:S1.
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