European Urology

Abstract

Objectives

As well as detecting prostate cancer, it is becoming increasingly important to estimate its location, size and grade. We aim to summarise current data on the efficacy of magnetic resonance imaging (MRI) in this setting.

Methods

Literature review of original research correlating MRI and histologic appearances.

Results

Estimates of the sensitivity of MRI for the detection of cancer vary widely depending on method of analysis used and the definition of significant disease. Recent estimates using T2-weighted sequences and endorectal coils vary from 60% to 96%. Several groups have convincingly shown that dynamic contrast enhancement and spectroscopy each improve detection and that the sensitivity of MRI is comparable to and may exceed that of transrectal biopsy. Specificity is not yet good enough to consider the use of MRI in screening. High-grade and large tumours are detected significantly more often with both T2 sequences and spectroscopy. Estimation of size is improved by dynamic contrast and spectroscopy, but errors of >25% are common.

Conclusions

The sensitivity of MRI has improved to the point that it has potential in several new areas: targeting of biopsies, monitoring of disease burden both during active surveillance and after focal therapy, and exclusion of cancer in patients with a raised prostate-specific antigen level.

Take Home Message

Magnetic resonance imaging of the prostate is improved by the addition of dynamic contrast enhancement and spectroscopy and will become an increasingly important tool for detecting and characterising prostate cancer.