The role of magnetic resonance imaging in prostate cancer
- Clare M C Tempany, MD
Clare M C Tempany, MD
- Professor of Radiology
- Harvard Medical School
- Peter Carroll, MD, MPH
Peter Carroll, MD, MPH
- Professor and Chair
- Department of Urology
- University of California, San Francisco
- Michael S Leapman, MD
Michael S Leapman, MD
- Urologic Oncology Fellow
- Department of Urology
- University of California San Francisco
- Section Editors
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
Prostate cancer will be diagnosed in approximately 181,000 men in the United States in 2016 and account for approximately 26,100 deaths . Although widespread use of serum prostate specific antigen (PSA) screening of healthy men has resulted in decreases in cancer-related mortality, this benefit has been accompanied by increased detection and treatment of many cancers bearing low metastatic potential . (See "Screening for prostate cancer", section on 'Prostate specific antigen (PSA)'.)
A priority in the management of the disease is the ability to accurately assess the presence of clinically significant lesions, the extent of disease at diagnosis, and to characterize the risk of future progression, thereby avoiding unnecessary treatment in men at low risk of progression.
Magnetic resonance imaging (MRI) offers increasingly reliable visualization of potentially significant prostate cancers and thus has shown advantages as a means by which to better select patients for biopsy and identify lesions for biopsy. MRI also provides information for staging the tumor extent and monitoring treatment response.
The technology of prostate MRI, the new prostate imaging reporting and data system (PI-RADS), and its current and potential clinical applications are reviewed in this topic.
Key advances that have contributed to the increased clinical utility of magnetic resonance imaging (MRI) of the prostate include the use of magnets with high field strength, the use of an endorectal coil, and the development of a novel set of imaging sequences that can be used in combination (so-called multiparametric MRI) to improve both lesion identification and characterization.
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- Magnet strength
- Endorectal coil
- Multiparametric imaging
- Prostate imaging reporting and data system (PI-RADS)
- CLINICAL APPLICATIONS
- Elevated serum PSA with a prior negative TRUS biopsy
- Initial presentation
- - Elevated PSA
- - Lesion localization
- - Targeted prostate biopsy
- - Lesion characterization
- - Staging
- Additional clinical settings
- - Active surveillance
- - Monitoring following initial therapy
- - Focal therapy