Abstract
Multi-parametric magnetic resonance imaging is an emerging imaging modality for diagnosis, staging, characterization, and treatment planning of prostate cancer. In this report, we reviewed the literature for studies assessing the accuracy of multi-parametric magnetic resonance imaging in detecting clinically significant prostate cancer, and we critically examined the future role of this imaging tool in various clinical diagnostic settings. There is accumulating evidence suggesting a high accuracy of multi-parametric magnetic resonance imaging in ruling out clinically significant disease. Although definition for clinically significant disease widely varies, the negative predictive value is very high at up to 98%. Multi-parametric magnetic resonance imaging should, thus, be further evaluated for application in different clinical scenarios in which it is desirable to reduce the proportion of unnecessary prostate biopsies and to limit the detection of indolent disease, such as opportunistic screening, persistent prostate cancer suspicion in men with previous negative prostate biopsies, and eligibility for active surveillance. Continued improvement in standardization of technical parameters, functional sequences, and image reporting systems is a pre-requisite for a rapid and successful dissemination of this imaging modality.
Highlights
In one large randomized trial, prostate-cancer (PCa) screening has resulted in a reduction in risk of metastatic disease and cancerspecific mortality [1]
THE FUTURE DIAGNOSTIC ROLE OF MULTI-PARAMETRIC MRI Based on the relatively high negative predictive value for “clinically significant disease,” it might not be impossible for MP-MRI to become a first-line screening tool
Compared to systematic transrectal ultrasound (TRUS)-guided prostate biopsy (PB), a diagnostic pathway including MP-MRI and selective MP-MRI-guided biopsy of equivocal or suspicious lesions reduced the need for biopsy by 51%, decreased the diagnosis of low-risk PCa by 89.4%, and increased the detection of intermediate/high-risk PCa by 17.7%
Summary
In one large randomized trial, prostate-cancer (PCa) screening has resulted in a reduction in risk of metastatic disease and cancerspecific mortality [1]. THE FUTURE DIAGNOSTIC ROLE OF MULTI-PARAMETRIC MRI Based on the relatively high negative predictive value for “clinically significant disease,” it might not be impossible for MP-MRI to become a first-line screening tool This would entail a major paradigm shift in PCa. By optimizing diagnosis, and subsequently preventing overtreatment of clinically insignificant disease, MPMRI-informed PB may provide a method for streamlining the diagnostic pathway in PCa. A recent prospective trial in PBnaïve men has provided promising results with this regard [22]. If DW-MRI alone combined with conventional T2-weighted MRI would prove to be www.frontiersin.org
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