Published online Mar 24, 2014. doi: 10.5410/wjcu.v3.i1.44
Revised: December 24, 2013
Accepted: January 14, 2014
Published online: March 24, 2014
Processing time: 141 Days and 15.2 Hours
Imaging plays an increasingly important role in the work up of prostate cancer (PCa) and magnetic resonance imaging (MRI) is generally accepted as the most accurate and promising imaging modality in the local staging of PCa due to its high spatial resolution and excellent soft tissue contrast. The quality and performance of MRI of the prostate has improved dramatically during the last decade. Mainly, the combination of morphological information and functional information on cell density, tissue perfusion or metabolism as provided in multi-parametric prostate MRI (mpMRI) has led to a substantial increase in lesion detection and characterization. The correlation between functional parameters as provided by MRI and the aggressiveness of PCa as determined by the Gleason Score may help in differentiating clinically significant from indolent PCa non-invasively. Besides these pros, radiologists are confronted with an immense amount of information and standardized acquisition, interpretation and reporting of mpMRI is not yet a reality. Furthermore, prostate MRI availability is still limited to high volume centers in many countries; hence, it is not yet a routine tool in common daily practice. Hence, development of guidelines for standardized acquisition, interpretation and reporting of prostate MRI exams is urgently needed in order to provide useful information for treating clinicians. Preferably, multi-centric clinical studies comparing MRI findings to step-section histological specimens are mandatory during the coming years. Furthermore, simplification of the acquisition must be achieved in order to make this imaging modality applicable for daily use in common uro-radiological practice.
Core tip: This review gives an overview about the current strengths and pitfalls of magnetic resonance imaging in the work up of clinical localized prostate cancer as well as suggestions for steps in the future.