Multiparametric MRI of the prostate: the hope for the urology community.

Abstract

The introduction of PSA in the early nineties of the previous century has strengthened interest in the screening of prostate cancer (PCa). The urology community soon indiscriminately adopted PSA testing, witnessing a revolution in the detection and treatment of PCa. Subsequently, two randomized trials confirmed the significant favorable influence of PSA-based screening on prostate cancer mortality. Surprisingly, the United States Preventive Services Task Force declined PSA testing as a PCa screening modality, highlighting unacceptable rates of overdiagnosis and overtreatment. These two have become the major challenges our societies have to overcome in order to implement widespread PCa screening programs. According to EAU Guidelines, the current strategy for detection of prostate cancer is based on TRUS-guided random systematic biopsy (TRUS-Bx) performed in men with elevated PSA and/or abnormal physical examination (DRE) [1]. Combined with other clinical characteristics, biopsy results are decisive in guiding a patient towards the most appropriate treatment modality, mainly either active surveillance (AS) or radical therapy. AS, tailored to cope with overdiagnosis, underestimates the stage or grade of disease in a third of cases, posing, at least theoretically, a risk to their prognosis. Therefore, there is an urgent need to embrace a detection tool that would diminish the rates of unnecessary biopsies leading to the diagnosis of insignificant PCa, improve risk stratification of those undergoing AS and guide the biopsy in those with previously negative TRUS-Bx to identify aggressive lesions that would be otherwise left undetected.