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.
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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.
• 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.
Insights into imaging. 2016 Feb 04 [Epub ahead of print]
Pieter J L De Visschere, Alberto Briganti, Jurgen J Fütterer, Pirus Ghadjar, Hendrik Isbarn, Christophe Massard, Piet Ost, Prasanna Sooriakumaran, Cristian I Surcel, Massimo Valerio, Roderick C N van den Bergh, Guillaume Ploussard, Gianluca Giannarini, Geert M Villeirs
Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. Department of Urology, Urological Research Institute, Vita-Salute University San Raffaele, Milan, Italy. , Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands. , Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany. , Department of Urology, Regio Clinic Wedel, Wedel, Germany. , Department of Oncology, Institut Gustave Roussy, University of Paris Sud, Villejuif, France. , Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium. , Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. , Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania. , Department of Urology, CHUV, Lausanne, Switzerland. , Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. , Urology Department, Saint Jean Languedoc Hospital, Toulouse, France. , Urology Unit, Academic Medical Centre Hospital «Santa Maria della Misericordia», Udine, Italy. , Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.