Skip to main content
Log in

Role of Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer

  • New Imaging Techniques (A Atala and A Rastinehad, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Prostate cancer is the most common solid-organ malignancy among American men. It is currently most commonly diagnosed on random systematic biopsies prompted by elevated serum PSA levels. Multi-parametric MRI (MP-MRI) of the prostate has emerged as an anatomic and functional imaging modality, which offers accurate detection, localization and staging of prostate cancer. Recently, MP-MRI has gained an increasing role in guiding biopsies to sites of abnormality and in monitoring patients on active surveillance. Here, we discuss the historical development, current role, and potential future directions of MP-MRI in the diagnosis of prostate cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Abbreviations

(bGS):

Biopsy Gleason Score

(B-MRI):

Biparametric MRI

(DWI):

Diffusion Weighted Imaging

(DRE):

Digital Rectal Examination

(MRI):

Magnetic Resonance Imaging

(MR/US):

Magnetic Resonance/Ultrasound

(MP-MRI):

Multiparametric MRI

(NPV):

Negative Predictive Value

(PPV):

Positive Predictive Value

(PCa):

Prostate Cancer

(PSA):

Prostate Specific Antigen

(PSAD):

PSA Density

(SPL):

Screen Positive Lesions

(T2W):

T2 Weighted

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

    Article  PubMed  Google Scholar 

  2. Derweesh IH, Kupelian PA, Zippe C, Levin HS, Brainard J, Magi-Galluzzi C, et al. Continuing trends in pathological stage migration in radical prostatectomy specimens. Urol Oncol. 2004;22(4):300–6.

    Article  PubMed  Google Scholar 

  3. Pinto PA, Chung PH, Rastinehad AR, Baccala Jr AA, Kruecker J, Benjamin CJ, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011;186(4):1281–5.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Hegde JV, Mulkern RV, Panych LP, Fennessy FM, Fedorov A, Maier SE, et al. Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging. 2013;37(5):1035–54.

    Article  PubMed  Google Scholar 

  5. Bloch BN, Genega EM, Costa DN, Pedrosa I, Smith MP, Kressel HY, et al. Prediction of prostate cancer extracapsular extension with high spatial resolution dynamic contrast-enhanced 3-T MRI. Eur Radiol. 2012;22(10):2201–10.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Poon PY, McCallum RW, Henkelman MM, Bronskill MJ, Sutcliffe SB, Jewett MA, et al. Magnetic resonance imaging of the prostate. Radiology. 1985;154(1):143–9.

    CAS  PubMed  Google Scholar 

  7. Dahms SE, Hohenfellner M, Linn JF, Eggersmann C, Haupt G, Thüroff JW. Retrovesical mass in men: pitfalls of differential diagnosis. J Urol. 1999;161:1244–8.

    Article  CAS  PubMed  Google Scholar 

  8. D’Amico AV, Schnall M, Whittington R, et al. Endorectal coil magnetic resonance imaging identifies locally advanced prostate cancer in select patients with clinically localized disease. Urology. 1998;51:449–54.

    Article  PubMed  Google Scholar 

  9. Sella T, Schwartz LH, Swindle PW, et al. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology. 2004;231:379–85.

    Article  PubMed  Google Scholar 

  10. Tatli S, Mortele KJ, Breen EL, Bleday R, Silverman SG. Local staging of rectal cancer using combined pelvic phased-array and endorectal coil MRI. J Magn Reson Imaging. 2006;23:534–40.

    Article  PubMed  Google Scholar 

  11. Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging prostate cancer: a multidisciplinary perspective. Radiology. 2007;243(1):28–53. Excellent review on multi-disciplinary imaging approach for prostate cancer.

    Article  PubMed  Google Scholar 

  12. Hambrock T, Somford DM, Huisman HJ, van Oort IM, Witjes JA. Hulsbergen-van de Kaa CA, Scheenen T, Barentsz JO. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 2011;259(2):453–61.

    Article  PubMed  Google Scholar 

  13. Hoeks CM, Barentsz JO, Hambrock T, Yakar D, Somford DM, Heijmink SW, et al. Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology. 2011;261(1):46–66.

    Article  PubMed  Google Scholar 

  14. Turkbey B, Mani H, Shah V, et al. Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol. 2011;186:1818–24. Important correlative study for multi-parametric prostate MRI since a patient specific customized mold is used for processing radical prostatectomy specimens.

    Article  PubMed  Google Scholar 

  15. Hegde JV, Mulkern RV, Panych LP, et al. Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging. 2013;37:1035–54.

    Article  PubMed  Google Scholar 

  16. Engelbrecht MR, Puech P, Colin P, Akin O, Lemaître L, Villers A. Multimodality magnetic resonance imaging of prostate cancer. J Endourol. 2010;24(5):677–84.

    Article  PubMed  Google Scholar 

  17. Zakian KL, Eberhardt S, Hricak H, et al. Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging–initial results. Radiology. 2003;229:241–7.

    Article  PubMed  Google Scholar 

  18. Turkbey B, Choyke PL. Multiparametric MRI and prostate cancer diagnosis and risk stratification. Curr Opin Urol. 2012;22:310–5.

    Article  PubMed  Google Scholar 

  19. Turkbey B, Mani H, Aras O, Ho J, Hoang A, Rastinehad A, Agarwal H, Shah V, Bernardo M, Pang Y, Daar D, McKinney YL, Linehan WM, Kaushal A, Merino MJ, Wood BJ, Pinto PA, Choyke PL. Can Multi-parametric MRI Identify Prostate Cancer Patients who are Candidates for Active Surveillance? Radiology. 2013;268:144–52.

  20. Engelhard K, Hollenbach HP, Kiefer B, Winkel A, Goeb K, Engehausen D. Prostate biopsy in the supine position in a standard 1.5-T scanner under real time MR-imaging control using a MR-compatible endorectal biopsy device. Eur Radiol. 2006;16:1237–43.

    Article  CAS  PubMed  Google Scholar 

  21. Zangos S, Melzer A, Eichler K, et al. MR-compatible assistance system for biopsy in a high-field-strength system: initial results in patients with suspicious prostate lesions. Radiology. 2011;259:903–10.

    Article  PubMed  Google Scholar 

  22. Hambrock T, Hoeks C. Hulsbergen-van de Kaa C, et al. Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. Eur Urol. 2012;61:177–84.

    Article  PubMed  Google Scholar 

  23. Kasivisvanathan V, Dufour R, Moore CM, et al. Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. J Urol. 2013;189:860–6.

    Article  PubMed  Google Scholar 

  24. Delongchamps NB, Peyromaure M, Schull A, et al. Prebiopsy magnetic resonance imaging and prostate cancer detection: comparison of random and targeted biopsies. J Urol. 2013;189:493–9.

    Article  PubMed  Google Scholar 

  25. Pinto PA, Chung PH, Rastinehad AR, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011;186:1281–5. One of the early studies, which compare TRUS/MRI fusion guided biopsy with systemic biopsy.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Beyersdorff D, Winkel A, Hamm B, Lenk S, Loening SA, Taupitz M. MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. Radiology. 2005;234:576–81.

    Article  PubMed  Google Scholar 

  27. Haffner J, Lemaitre L, Puech P, et al. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int. 2011;108:E171–8.

    Article  PubMed  Google Scholar 

  28. Park BK, Park JW, Park SY, et al. Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR Am J Roentgenol. 2011;197:W876–81.

    Article  PubMed  Google Scholar 

  29. Puech P, Rouvière O, Renard-Penna R, Villers A, Devos P, Colombel M, et al. Prostate Cancer Diagnosis: Multiparametric MR-targeted Biopsy with Cognitive and Transrectal US-MR Fusion Guidance versus Systematic Biopsy–Prospective Multicenter Study. Radiology. 2013;268(2):461–9.

    Article  PubMed  Google Scholar 

  30. Rais-Bahrami S, Siddiqui MM, Turkbey B, Stamatakis L, Logan J, Hoang AN, et al. Usefulness of Multiparametric Magnetic Resonance Imaging Suspicion Levels in Detecting Prostate Cancer. J Urol. 2013. doi:10.1016/j.juro.2013.05.052.

    Google Scholar 

  31. Sonn GA, Natarajan S, Margolis DJ, et al. Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device. J Urol. 2013;189:86–91.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, et al. Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Significantly Upgrades Prostate Cancer Versus Systematic 12-core Transrectal Ultrasound Biopsy. Eur Urol. 2013. doi:10.1016/j.eururo.2013.05.059.

    Google Scholar 

  33. Vourganti S, Rastinehad A, Yerram NK, Nix J, Volkin D, Hoang A, et al. Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol. 2012;188(6):2152–7.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Sonn GA, Chang E, Natarajan S, Margolis DJ, Macairan M, Lieu P, Huang J, Dorey FJ, Reiter RE, Marks LS. Value of Targeted Prostate Biopsy Using Magnetic Resonance-Ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-specific Antigen. Eur Urol. 2013. doi:10.1016/j.eururo.2013.03.025.

  35. Roethke M, Anastasiadis AG, Lichy M, et al. MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol. 2012;30:213–8.

    Article  CAS  PubMed  Google Scholar 

  36. Franiel T, Stephan C, Erbersdobler A, et al. Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding–multiparametric MR imaging for detection and biopsy planning. Radiology. 2011;259:162–72.

    Article  PubMed  Google Scholar 

  37. Komai Y, Numao N, Yoshida S, et al. High Diagnostic Ability of Multiparametric Magnetic Resonance Imaging to Detect Anterior Prostate Cancer Missed by Transrectal 12-Core Biopsy. J Urol. 2013;190:867–73

    Google Scholar 

  38. Ouzzane A, Puech P, Lemaitre L, Leroy X, Nevoux P, Betrouni N, et al. Combined multiparametric MRI and targeted biopsies improve anterior prostate cancer detection, staging, and grading. Urology. 2011;78(6):1356–62.

    Article  PubMed  Google Scholar 

  39. Nix JW, Turkbey B, Hoang A, Volkin D, Yerram N, Chua C, et al. Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla. BJU Int. 2012;110(11 Pt B):E694–700.

    Article  PubMed  Google Scholar 

  40. Walton-Diaz A, Hoang AN, Turkbey B, Hong CW, Truong H, Sterling T, et al. Can MR-US Fusion Biopsy Improve Cancer Detection in Enlarged Prostates? J Urol. 2013. doi:10.1016/j.juro.2013.05.118.

    Google Scholar 

  41. Moyer VA. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:120.

    Article  PubMed  Google Scholar 

  42. Andriole GL, Crawford ED, Grubb 3rd RL, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. ERSPC Investigators. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med. 2012;366(11):981–90.

    Article  PubMed  Google Scholar 

  44. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203–13. doi:10.1056/NEJMoa1113162.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Villers A, Puech P. When and How Should Magnetic Resonance Imaging be Used in Evaluation of the Patient with Prostate Cancer or Increased Prostate Specific Antigen? J Urol. 2013. doi:10.1016/j.juro.2013.08.014.

    Google Scholar 

  46. Villers A, Marliere F, Ouzzane A, Puech P, Lemaître L. MRI in addition to or as a substitute for prostate biopsy: the clinician’s point of view. Diagn Interv Imaging. 2012;93(4):262–7.

    Article  CAS  PubMed  Google Scholar 

  47. Fütterer JJ. MR imaging in local staging of prostate cancer. Eur J Radiol. 2007;63:328.

    Article  PubMed  Google Scholar 

  48. Soylu FN, Eggener S, Oto A. Local staging of prostate cancer with MRI. Diagn Interv Radiol. 2012;18(4):365–73.

    PubMed  Google Scholar 

  49. Soylu FN, Peng Y, Jiang Y, Wang S, Schmid-Tannwald C, Sethi I, et al. Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging. Radiology. 2013;267(3):797–806.

    Article  PubMed  Google Scholar 

  50. Jeong IG, Lim JH, You D, Kim MH, Choi HJ, Kim JK, et al. Incremental Value of Magnetic Resonance Imaging for Clinically High Risk Prostate Cancer: A Large Single institution Experience of 922 Radical Prostatectomies. J Urol. 2013. doi:10.1016/j.juro.2013.06.035.

    Google Scholar 

  51. Yerram NK, Volkin D, Turkbey B, Nix J, Hoang AN, Vourganti S, et al. Low suspicion lesions on multiparametric magnetic resonance imaging predict for the absence of high-risk prostate cancer. BJU Int. 2012;110(11 Pt B):E783–8.

    Article  PubMed  Google Scholar 

  52. Somford DM, Hamoen EH, Fütterer JJ, van Basten JP. Hulsbergen-van de Kaa CA, Vreuls W, van Oort IM, Vergunst H, Kiemeney LA, Barentsz JO, Witjes JA. The Predictive Value of Endorectal 3 Tesla Multiparametric Magnetic Resonance Imaging for Extraprostatic Extension in Patients with Low, Intermediate and High Risk Prostate Cancer. J Urol. 2013;190:1728.

    Article  CAS  PubMed  Google Scholar 

  53. Turkbey B, Mani H, Aras O, Ho J, Hoang A, Rastinehad AR, et al. Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology. 2013;268(1):144–52.

    Article  PubMed  Google Scholar 

  54. Stamatakis L, Siddiqui MM, Nix JW, Logan J, Rais-Bahrami S, Walton-Diaz A, et al. Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer. 2013. doi:10.1002/cncr.28216.

    PubMed  Google Scholar 

  55. Ouzzane A, Puech P, Villers A. MRI and surveillance. Curr Opin Urol. 2012;22(3):231–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Center for Cancer Research, and the Center for Interventional Oncology. NIH and Philips Healthcare have a cooperative research and development agreement. NIH and Philips share intellectual property in the field.

We also thank the administrative support staff of the Urologic Oncology Branch, Center for Cancer Research for assisting with the manuscript review and submission process.

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Soroush Rais-Bahrami, Dr. Baris Turkbey, Dr. Kinzya B. Grant, Dr. Peter A. Pinto, and Dr. Peter L. Choyke each declare no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Baris Turkbey.

Additional information

This article is part of the Topical Collection on New Imaging Techniques

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rais-Bahrami, S., Turkbey, B., Grant, K.B. et al. Role of Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer. Curr Urol Rep 15, 387 (2014). https://doi.org/10.1007/s11934-013-0387-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-013-0387-9

Keywords

Navigation