What is the relevance MRI in prostate cancer? - Multiparametric MRI
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Multiparametric magnetic resonance imaging (mpMRI) is a powerful new tool which is changing the landscape of prostate cancer1. It provides greater accuracy for the following:
mpMRI has been shown to be very specific for prostate cancer, in the order of 90-95% accuracy8. It has the ability to overcome the limitations of PSA monitoring and digital rectal examination (DRE).
Biopsies
Targeted mpMRI prostate biopsies have the potential to revolutionise prostate cancer diagnosis and management. By directly combining mpMRI and ultrasound imaging to produce a fusion image, the prostate cancer can be accurately localised. Real time biopsies can be taken with higher accuracy using this fusion image to guide the needle4. Significant medical research demonstrates that mpMRI guided biopsies have higher detection rates, more accuracy at predicting aggressive cancers and lower complication rates9.
Staging of prostate cancer
mpMRI allows more accurate definition of the exact boundaries of the prostate cancer which is invaluable in determining if the prostate cancer has spread beyond the confines of the capsule.5 This is critical in selecting the appropriate type of treatment.
Monitoring of prostate cancer
Patients with a low grade prostate cancer are often placed on active surveillance after an initial biopsy. mpMRI is providing a non-invasive option replacing the need for multiple regular biopsies6.
Focal therapy
By more accurate sampling and localisation of the prostate, focal therapy (removal of the lesion without removing the entire prostate) will become a real option for prostate cancer patients. It is in its formative stages but will have an increasing role in the treatment of prostate cancer7.
2. Henry H. Woo, Hadia Khanani, Nadine J. Thompson, et al - Multiparametric Magnetic Resonance Imaging of the Prostate and Prostate-specific Membrane Positron Emission Tomography Prior to Prostate Biopsy (MP4 Study) - Eur Urol Open Sci. 2023 Jan; 47: 119–125 - doi: 10.1016/j.euros.2022.11.012
3. Hashim U Ahmed, Ahmed El-Shater Bosaily, Louise C Brown, et al - Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study - The Lancet - DOI:https://doi.org/10.1016/S0140-6736(16)32401-1
4. Kesley Pedler, Yu Xuan Kitzing, Celi Varol, et al - The current status of MRI in prostate cancer - Australian Family Physician - Volume 44, Issue 4, April 2015
5. Tiago Oliveira, Luis Amaral Ferreira, et al - The Role of Multiparametric MRI in the Local Staging of Prostate Cancer - Front. Biosci. (Elite Ed) 2023, 15(3), 21; - DOI: 10.31083/j.fbe1503021
6. Chau Hung Lee,1 Teck Wei Tan,2 and Cher Heng Tan - Multiparametric MRI in Active Surveillance of Prostate Cancer: An Overview and a Practical Approach - Korean J Radiol. 2021 Jul;22(7):1087-1099. English - https://doi.org/10.3348/kjr.2020.1224
7. John R Heard, Aurash Naser-Tavakolian, Michael Nazmifar - Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes - Prostate Cancer Prostatic Dis . 2023 Jun;26(2):218-227 - DOI: 10.1038/s41391-022-00501-0
8. Martina Martins, Stefano Regusci, Stephane Rohner - The diagnostic accuracy of multiparametric MRI for detection and localization of prostate cancer depends on the affected region - BJUI Compass. 2021 May; 2(3): 178–187 - doi: 10.1002/bco2.62
9. Lars Schimmöller, Dirk Blondin, Christian Arsov - MRI-Guided In-Bore Biopsy: Differences Between Prostate Cancer Detection and Localization in Primary and Secondary Biopsy Settings - Volume 206, Issue 1 - American Journal of Roentgenology - https://ajronline.org/doi/full/10.2214/AJR.15.14579
- Diagnosis2, 3
- Biopsies4
- Staging of prostate cancer5
- Monitoring of prostate cancer6
- Focal therapy7
mpMRI has been shown to be very specific for prostate cancer, in the order of 90-95% accuracy8. It has the ability to overcome the limitations of PSA monitoring and digital rectal examination (DRE).
Biopsies
Targeted mpMRI prostate biopsies have the potential to revolutionise prostate cancer diagnosis and management. By directly combining mpMRI and ultrasound imaging to produce a fusion image, the prostate cancer can be accurately localised. Real time biopsies can be taken with higher accuracy using this fusion image to guide the needle4. Significant medical research demonstrates that mpMRI guided biopsies have higher detection rates, more accuracy at predicting aggressive cancers and lower complication rates9.
Staging of prostate cancer
mpMRI allows more accurate definition of the exact boundaries of the prostate cancer which is invaluable in determining if the prostate cancer has spread beyond the confines of the capsule.5 This is critical in selecting the appropriate type of treatment.
Monitoring of prostate cancer
Patients with a low grade prostate cancer are often placed on active surveillance after an initial biopsy. mpMRI is providing a non-invasive option replacing the need for multiple regular biopsies6.
Focal therapy
By more accurate sampling and localisation of the prostate, focal therapy (removal of the lesion without removing the entire prostate) will become a real option for prostate cancer patients. It is in its formative stages but will have an increasing role in the treatment of prostate cancer7.
References
1. Les C Thompson and Morgan R Pokorny - Multiparametric MRI in the diagnosis of prostate cancer – a generational change - Australian Family Physician - Volume 44, Issue 8, August 20152. Henry H. Woo, Hadia Khanani, Nadine J. Thompson, et al - Multiparametric Magnetic Resonance Imaging of the Prostate and Prostate-specific Membrane Positron Emission Tomography Prior to Prostate Biopsy (MP4 Study) - Eur Urol Open Sci. 2023 Jan; 47: 119–125 - doi: 10.1016/j.euros.2022.11.012
3. Hashim U Ahmed, Ahmed El-Shater Bosaily, Louise C Brown, et al - Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study - The Lancet - DOI:https://doi.org/10.1016/S0140-6736(16)32401-1
4. Kesley Pedler, Yu Xuan Kitzing, Celi Varol, et al - The current status of MRI in prostate cancer - Australian Family Physician - Volume 44, Issue 4, April 2015
5. Tiago Oliveira, Luis Amaral Ferreira, et al - The Role of Multiparametric MRI in the Local Staging of Prostate Cancer - Front. Biosci. (Elite Ed) 2023, 15(3), 21; - DOI: 10.31083/j.fbe1503021
6. Chau Hung Lee,1 Teck Wei Tan,2 and Cher Heng Tan - Multiparametric MRI in Active Surveillance of Prostate Cancer: An Overview and a Practical Approach - Korean J Radiol. 2021 Jul;22(7):1087-1099. English - https://doi.org/10.3348/kjr.2020.1224
7. John R Heard, Aurash Naser-Tavakolian, Michael Nazmifar - Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes - Prostate Cancer Prostatic Dis . 2023 Jun;26(2):218-227 - DOI: 10.1038/s41391-022-00501-0
8. Martina Martins, Stefano Regusci, Stephane Rohner - The diagnostic accuracy of multiparametric MRI for detection and localization of prostate cancer depends on the affected region - BJUI Compass. 2021 May; 2(3): 178–187 - doi: 10.1002/bco2.62
9. Lars Schimmöller, Dirk Blondin, Christian Arsov - MRI-Guided In-Bore Biopsy: Differences Between Prostate Cancer Detection and Localization in Primary and Secondary Biopsy Settings - Volume 206, Issue 1 - American Journal of Roentgenology - https://ajronline.org/doi/full/10.2214/AJR.15.14579