Abstract
Purpose: Transrectal ultrasound (TRUS) has been the gold standard of imaging for diagnosing prostate cancer for decades but is plagued by user error and undersampling. We aim to explore imaging modalities that are now being used in combination or alone for screening, diagnosis, and/or active surveillance of prostate cancer.Methods: A PubMed literature search was performed to include articles published up to April 2016. Data were extracted and analyzed.Results: Several large-scale studies have found an increased cancer detection rate in MRI-targeted lesions with an improved ability to target anterior lesions as well as an increased cancer detection in high-risk cancers using fusion platforms vs TRUS alone.Conclusions: To date, there have been few head-to-head trials to directly compare the use of multiparametric MRI (mpMRI), transrectal ultrasound, and MRI-ultrasound fusion modalities for accurate and reliable detection, active surveillance, or biopsy procedure success rates. Further investigation utilizing these modalities are needed before they can be relied upon in active surveillance management, although mpMRI appears to be currently the most reliable in monitoring and diagnosing prostate lesions.
Highlights
BackgroundProstate-specific antigen (PSA) has been the gold standard screening test for prostate cancer since its approval by the FDA in 1986 [1]
We look to discuss other imaging modalities that may be used for screening, diagnosis, and active surveillance of prostate cancer that may result in more sensitive testing and lower the false positives or better classify and/or monitor low disease burden
The Magnetic resonance imaging (MRI)-Transrectal ultrasound (TRUS) technique was shown to reduce the number of biopsies done on patients that have low-grade Prostate cancer (PCa), reducing the overall diagnoses of low-grade prostate cancers, and increasing the detection of the intermediate and high-risk subgroups of patients compared to traditional modalities [26, 42]
Summary
The TRUS biopsy procedure is highly user-dependent and subject to sampling errors in comparison to mpMRI or fusion modalities. With the added benefits of imaging clarity in MpMRI and standardization with the PI-RADS v2 guidelines, urologists may be more likely to find foci of high-grade tumors and less likely to miss aggressive tumors All of these methods have shown the potential to overcome the limitations of traditional biopsy methods, namely, false-negative biopsies, false risk stratification, and identifying clinically insignificant tumors incidentally. Fusion modalities allow the user to incorporate real-time ultrasound findings with MRI integration It has been proven by study after study to improve the detection of clinically significant PCa. It has been proven by study after study to improve the detection of clinically significant PCa In light of these studies, we believe the less invasive MpMRI is an accurate and reliable way to diagnose and monitor prostate lesions
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