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MRI for men undergoing active surveillance or with rising PSA and negative biopsies

Nature Reviews Urology volume 7, pages 543–551 (2010)Cite this article

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Abstract

The role of imaging in treatment decision-making for patients with prostate cancer is to characterize the cancer already diagnosed on biopsy, to determine tumor location, to assess tumor volume, and to exclude more-extensive disease. MRI is currently the most established imaging modality for this purpose, with the highest sensitivity and specificity for detection and staging of prostate tumors. The development and wider adoption of active surveillance and focal treatment approaches would also benefit from accurate localization of cancer. As such, 3 T MRI and multiparametric approaches are being developed as tools for the localization and staging of prostate cancer. Men wishing to commence or remain on active surveillance might benefit by having larger cancers identified before embarking on this management strategy. MRI might have its greatest role in patients where there is a discrepancy between PSA and biopsy results suggesting a potential missed prostate tumor.

Key Points

  • 3 T MRI and multiparametric approaches are being developed as tools for localization and staging of prostate cancer

  • The increased accuracy of MRI for prostate cancer detection has been critical for appropriate patient selection to active surveillance and focal therapy for low-risk disease, thus avoiding overtreatment

  • Men wishing to commence or remain on active surveillance might benefit from having larger cancers identified before embarking on this approach

  • MRI might have its greatest role in patients where there is a discrepancy between PSA and biopsy results suggesting a potential missed prostate tumor

  • A cost–benefit analysis must be performed in all cases where MRI is under consideration, to ensure that the relatively small pool of resources is used appropriately

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Figure 1: Staging prostate cancer with MRI.
Figure 2: Prostate cancer localization using multiparametric MRI in a patient on active surveillance.
Figure 3: Multiparametric MRI of a small Gleason 7 (3 + 4) tumor in the left peripheral zone of the prostate.

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Authors and Affiliations

  1. Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Hospital, 610 University Avenue 3-130, Toronto, M5G 2M9, ON, Canada

    Orit Raz, John Trachtenberg & Nathan Lawrentschuk

  2. Department of Medical Imaging, University of Toronto, Princess Margaret Hospital, 610 University Avenue 3-130, Toronto, M5G 2M9, ON, Canada

    Masoom Haider

  3. Department of Urology, Assaf Harofeh Medical Center, Beer–Yaakov, 70300, Zerifin, Israel

    Dan Leibovici

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O. Raz and N. Lawrentschuk researched data, discussed content, wrote the article and reviewed the manuscript. M. Haider, J. Trachtenberg and D. Leibovici made substantial contributions to the researching, discussion and reviewing of the manuscript.

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Correspondence to Nathan Lawrentschuk.

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Raz, O., Haider, M., Trachtenberg, J. et al. MRI for men undergoing active surveillance or with rising PSA and negative biopsies. Nat Rev Urol 7, 543–551 (2010). https://doi.org/10.1038/nrurol.2010.143

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