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The Use of Multiparametric Magnetic Resonance Imaging (mpMRI) in the Detection, Evaluation, and Surveillance of Clinically Significant Prostate Cancer (csPCa)

  • Prostate Cancer (S Prasad, Section Editor)
  • Published:
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Abstract

Purpose of Review

With the long-standing controversy surrounding the use of prostate-specific antigen (PSA) for the detection, evaluation, and surveillance of prostate cancer, there is a need for a minimally invasive technique to identify and risk-stratify these patients. Additionally, in an effort to reduce the number of unnecessary biopsies and identify clinically significant prostate cancer (csPCa), there has been a shift in practice towards the use of multiparametric magnetic resonance imaging (mpMRI) in conjunction with decision-making regarding prostate cancer diagnosis and management. In the current review, we summarize the data regarding the use of mpMRI in the detection, evaluation, and surveillance of csPCa.

Recent Findings

Recent prospective clinical trials have determined that a pre-biopsy mpMRI may rule out insignificant prostate cancers, thereby reducing the number of patients who require a biopsy. The anatomic information gathered from these pre-biopsy mpMRI performed during MRI fusion biopsy in csPCa increases the accuracy of pathologic staging in terms of Gleason scores. In regard to active surveillance, prospective trials suggest little to no clinical utility for mpMRI and fusion biopsy in the surveillance of prostate cancer despite conflicting findings from retrospective studies.

Summary

Recent trials suggest that mpMRI can play an important role in the detection and evaluation of csPCa. The ideal role for mpMRI in active surveillance remains limited.

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Abbreviations

mpMRI:

multiparametric magnetic resonance imaging

csPCa:

clinically significant prostate cancer

FB:

fusion biopsy

SB:

systematic biopsy

GS:

Gleason score

OR:

odds ratio

HSROC:

hierarchical summary receiver-operating curve

AUC:

area under the curve

GG:

Gleason grade

TP:

true positive

FP:

false positive

TN:

true negative

FN:

false negative

PPV:

positive predictive value

NPV:

negative predictive value

ROI:

regions of interest

CI:

confidence interval

IT:

index tumor

TRUS:

transrectal ultrasound

DRE:

digital rectal exam

PSA:

prostate-specific antigen

NND:

number needed to diagnose

NNM:

number needed to misdiagnose

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA

    Parth Patel, Shu Wang & Mohummad Minhaj Siddiqui

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  1. Parth Patel
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Correspondence to Mohummad Minhaj Siddiqui.

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Parth Patel, Shu Wang, and Mohummad Minhaj Siddiqui each declare no potential conflicts of interest.

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Patel, P., Wang, S. & Siddiqui, M.M. The Use of Multiparametric Magnetic Resonance Imaging (mpMRI) in the Detection, Evaluation, and Surveillance of Clinically Significant Prostate Cancer (csPCa). Curr Urol Rep 20, 60 (2019). https://doi.org/10.1007/s11934-019-0926-0

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