Abstract
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
Highlights
Since the discovery of prostate-specific antigen (PSA) in the 1970s the disease management of prostate cancer (PCa) has shifted tremendously [1]
We present an overview of the current practices and challenges of the critical role held by MR imaging in the treatment of native and recurrent PCa
BpMRI and multiparametric MRI (mpMRI) showed similar sensitivities and specificities for the detection rates [30,31,32]. Another reason to use the biparametric MRI (bpMRI) for detection of PCa is the fact that DCE-Magnetic resonance imaging (MRI) only plays a minor role in determining the PI-RADS Assessment Category, as it does not contribute to the overall assessment when the lesion has a low PI-RADS (1 or 2) or high PI-RADS score (4 or 5)
Summary
Since the discovery of prostate-specific antigen (PSA) in the 1970s the disease management of prostate cancer (PCa) has shifted tremendously [1]. Current active treatment in localized low-, intermediate- and high-risk PCa consists of whole gland treatment, i.e., radical prostatectomy (RP) and radiotherapy (including external beam radiotherapy (EBRT) and brachytherapy). These therapies are associated with a high risk of developing incontinence (16%) and erectile dysfunction (34%) [4,5], and a substantial risk of developing second malignancies of the bladder, colon and rectum (adjusted hazard ratio of 1.67, 1.33–1.79 and 1.64–1.79), urethral stricture (2.2%) and bowel dysfunction [6,7,8,9]. We present an overview of the current practices and challenges of the critical role held by MR imaging in the treatment of native and recurrent PCa. We will focus on the role of MRI in the real time guiding of (focal) therapy
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