Multiparametric magnetic resonance imaging of the prostate: Current status in prostate cancer detection, localization, and staging

MRI has been shown to be a useful imaging technique for prostate cancer detection, localization, and staging. Currently, state of-the-art prostate MRI should be performed using a combined endorectal and surface pelvic coil with a magnetic field strength of at least 1.5 T. With the increasing experience and standardization of imaging protocols at 3 T, true gains in SNR will be fully translated into improved diagnostic performance. For prostate cancer detection the combined conventional MRI, providing anatomic detail, and functional MRI approach, providing additional metabolic/perfusion information, has shown promising results. Combined conventional and functional MRI approach seems to be most useful for patients with elevated or increasing PSA and negative TRUS biopsies, and for staging high-risk patients who are at risk for ECE. Functional techniques may allow for in vivo assessment of tumor aggressiveness. A combined conventional and functional MRI approach may play a role in monitoring patients with prostate cancer who select watchful waiting or other new minimally invasive cancer therapies. MRI still has several limitations, mainly limited availability, high costs, and the lack of standardized imaging parameters. Differentiation between prostate cancer and prostatitis is still a major problem, as both MRSI and DCE-MRI may demonstrate in prostatitis metabolic/perfusion abnormality that leads to false-positive diagnosis of cancer. The overlap between ADC values for cancer and benign tissues in the prostate also affect the specificity of DWI. MRI of the prostate is still evolving and as the technology matures and new tools for analysis of vast data from multiparametric imaging become available, we should expect that MRI's role will solidify. However, larger clinical studies are necessary, to allow us to fully understand and document the value of MRI in prostate cancer diagnosis and management. © 2008 Elsevier Inc. All rights reserved.