Current Urology Reports

, Volume 13, Issue 1, pp 82–92 | Cite as

Value of Multiparametric MRI in the Work-up of Prostate Cancer

  • F. CornudEmail author
  • N. B. Delongchamps
  • P. Mozer
  • F. Beuvon
  • A. Schull
  • N. Muradyan
  • M. Peyromaure
New Techniques: Imaging (A Atala, Section Editor)


The role of magnetic resonance imaging (MRI) in prostate cancer evaluation is controversial and likely underestimated. Technological advances over the past 5 years have demonstrated that multiparametric MRI, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI, can evaluate the actual tumor burden of a newly diagnosed prostate cancer more accurately than sextant biopsy protocols. Tumor risk, defined by the D’Amico criteria, hence can be re-evaluated by multiparametric MRI. As a result, there is increasing evidence that MRI before repeat or even initial biopsy can accurately select patients who require immediate biopsies and those in whom biopsy could be deferred. Also, a relationship between apparent diffusion coefficient (ADC), calculated from DWI, and Gleason score was found. Thus, MRI before biopsy helps to detect high-grade tumors to target biopsies within areas of low ADC values. To achieve good targeting accuracy, transrectal ultrasound (TRUS)-MRI image registration is necessary. Three-dimensional deformable registration is sufficiently accurate to match TRUS and MRI volumes with a topographic precision of 1 mm. Real-time MRI-guided biopsy is another technique under evaluation. Both approaches will allow for increasing acceptance of focal therapies, should these techniques be validated in the future.


Prostate cancer Magnetic resonance imaging MRI Multiparametric MRI D’Amico criteria Prebiopsy MRI Transrectal ultrasound TRUS-MRI image fusion 



No potential conflicts of interest relevant to this article were reported.


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

  1. 1.
    Afaq A, Koh DM, Padhani A, van As N, Sohaib SA. Clinical utility of diffusion-weighted magnetic resonance imaging in prostate cancer. BJU Int. 2011 Jun 1Google Scholar
  2. 2.
    D’Amico AV, Renshaw AA, Cote K, Hurwitz M, Beard C, Loffredo M, et al. Impact of the percentage of positive prostate cores on prostate cancer-specific mortality for patients with low or favorable intermediate-risk disease. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2004;22(18):3726–32.CrossRefGoogle Scholar
  3. 3.
    • Stark JR, Perner S, Stampfer MJ, Sinnott JA, Finn S, Eisenstein AS, et al. Gleason score and lethal prostate cancer: does 3 + 4 = 4 + 3? J Clin Oncol. 2009 Jul 20;27(21):3459–64. For prostatectomy specimens, 4 +3 cancers were associated with a threefold increase in lethal prostate cancer compared with 3 +4 cancers. This important finding has led to classify tumors with a Gleason score 7, 4 +3 on TRUS-guided biopsies in the high-risk group. PubMedCrossRefGoogle Scholar
  4. 4.
    Epstein JI, Chan DW, Sokoll LJ, Walsh PC, Cox JL, Rittenhouse H, et al. Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol. 1998;160(6 Pt 2):2407–11.PubMedGoogle Scholar
  5. 5.
    • Lawrentschuk N, Haider MA, Daljeet N, Evans A, Toi A, Finelli A, et al. ‘Prostatic evasive anterior tumours’: the role of magnetic resonance imaging. BJU Int. 2010 May;105(9):1231–6. This is one of the first papers to suggest that tumor burden of anterior tumors was commonly underestimated by a standard 12 posterior core sextant biopsy protocol. PubMedCrossRefGoogle Scholar
  6. 6.
    Alonzi R, Padhani AR, Allen C. Dynamic contrast enhanced MRI in prostate cancer. Eur J Radiol. 2007;63(3):335–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Seitz M, Shukla-Dave A, Bjartell A, Touijer K, Sciarra A, Bastian PJ, et al. Functional magnetic resonance imaging in prostate cancer. European urology [Review]. 2009;55(4):801–14.CrossRefGoogle Scholar
  8. 8.
    Noldus J, Graefen M, Haese A, Henke RP, Hammerer P, Huland H. Stage migration in clinically localized prostate cancer. Eur Urol. 2000;38(1):74–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Scattoni V, Zlotta A, Montironi R, Schulman C, Rigatti P, Montorsi F. Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature. Eur Urol. 2007;52(5):1309–22.PubMedCrossRefGoogle Scholar
  10. 10.
    Giannarini G, Autorino R, di Lorenzo G. Saturation biopsy of the prostate: why saturation does not saturate. Eur Urol. 2009;56(4):619–21.PubMedCrossRefGoogle Scholar
  11. 11.
    • Delongchamps NB, de la Roza G, Jones R, Jumbelic M, Haas GP. Saturation biopsies on autopsied prostates for detecting and characterizing prostate cancer. BJU Int. 2009 Jan;103(1):49–54. The evaluation of saturation biopsies based on the true prevalence of prostate cancer showed no increase in detection rate over a less extensive 18-core biopsy. PubMedCrossRefGoogle Scholar
  12. 12.
    • Delongchamps NB, Beuvon F, Eiss D, Flam T, Muradyan N, Zerbib M, et al. Multiparametric MRI is helpful to predict tumor focality, stage, and size in patients diagnosed with unilateral low-risk prostate cancer. Prostate cancer and prostatic diseases. 2011 Sep;14(3):232–7. With optimal MR combinations, tumor size was correctly estimated in 77% of tumor foci involving more than one octant. Bilateral tumors were detected in 80% (16/20) of cases. In patients with unilateral low-risk prostate cancer on biopsy, multiparametric MRI can help to predict bilateral involvement. PubMedCrossRefGoogle Scholar
  13. 13.
    • Delongchamps NB, Rouanne M, Flam T, Beuvon F, Liberatore M, Zerbib M, et al. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int. 2010 Nov 2. Adding DWI and DCE to T2W imaging significantly increased MRI performance in cancer detection in the PZ. Google Scholar
  14. 14.
    Futterer JJ, Heijmink SW, Scheenen TW, Veltman J, Huisman HJ, Vos P, et al. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology. 2006;241(2):449–58.PubMedCrossRefGoogle Scholar
  15. 15.
    Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol. 2006;176(6 Pt 1):2432–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Girouin N, Mege-Lechevallier F, Tonina Senes A, Bissery A, Rabilloud M, Marechal JM, et al. Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur Radiol. 2007;17(6):1498–509.PubMedCrossRefGoogle Scholar
  17. 17.
    Haider MA, van der Kwast TH, Tanguay J, Evans AJ, Hashmi A-T, Lockwood G, et al. Combined T2-Weighted and Diffusion-Weighted MRI for Localization of Prostate Cancer. Am J Roentgenol. 2007;189(2):323–8.CrossRefGoogle Scholar
  18. 18.
    Yoshizako T, Wada A, Hayashi T, Uchida K, Sumura M, Uchida N, et al. Usefulness of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the diagnosis of prostate transition-zone cancer. Acta radiologica Evaluation Studies. 2008;49(10):1207–13.Google Scholar
  19. 19.
    deSouza NM, Riches SF, Vanas NJ, Morgan VA, Ashley SA, Fisher C, et al. Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer. Clin Radiol. 2008;63(7):774–82.PubMedCrossRefGoogle Scholar
  20. 20.
    Koksal IT, Ozcan F, Kadioglu TC, Esen T, Kilicaslan I, Tunc M. Discrepancy between Gleason Scores of Biopsy and Radical Prostatectomy Specimens. Eur Urol. 2000;37(6):670–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Hambrock T, Hoeks C, Hulsbergen-van de Kaa C, Scheenen T, Futterer J, Bouwense S, 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. European urology. 2011 Aug 27.Google Scholar
  22. 22.
    Verma S, Rajesh A, Morales H, Lemen L, Bills G, Delworth M, et al. Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy. AJR Am J Roentgenol. 2011;196(2):374–81.PubMedCrossRefGoogle Scholar
  23. 23.
    •• Giles SL, Morgan VA, Riches SF, Thomas K, Parker C, deSouza NM. Apparent diffusion coefficient as a predictive biomarker of prostate cancer progression: value of fast and slow diffusion components. AJR American journal of roentgenology. Research Support NonUS Gov’t 2011;196(3):586–91. In patients managed by active surveillance, repeat biopsies showed that both fast and slow diffusion components were significantly lower in tumors that were subsequently upgraded on histology. On DWI-MRI, both tumor volume and the true diffusion ADC (slow) were significant but independent predictors of histologic progression. Google Scholar
  24. 24.
    Polascik TJ, Mayes JM, Schroeck FR, Sun L, Madden JF, Moul JW, et al. Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy. Cancer. 2009;115(10):2104–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Engelbrecht MR, Jager GJ, Laheij RJ, Verbeek AL, Van Lier HJ, Barentsz JO. Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur Radiol. 2002;12(9):2294–302.PubMedGoogle Scholar
  26. 26.
    Graser A, Heuck A, Sommer B, Massmann J, Scheidler J, Reiser M, et al. Per-sextant localization and staging of prostate cancer: correlation of imaging findings with whole-mount step section histopathology. AJR Am J Roentgenol. 2007;188(1):84–90.PubMedCrossRefGoogle Scholar
  27. 27.
    Labanaris AP, Engelhard K, Zugor V, Nutzel R, Kuhn R. Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate. Prostate Cancer Prostatic Dis. 2010;13(1):65–70.PubMedCrossRefGoogle Scholar
  28. 28.
    Azancot V, Peyromaure M, Xylinas E, Descazeaud A, Cornud F, Vieillefond A, et al. Analysis of anatomopathological results of radical prostatectomy specimen of patients who answer to criteria for active surveillance of prostate cancer. Prog Urol. 2009;19(9):619–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Jager GJ, Ruijter ET, van de Kaa CA, de la Rosette JJ, Oosterhof GO, Thornbury JR, et al. Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am J Roentgenol. 1996;166(4):845–52.PubMedGoogle Scholar
  30. 30.
    Fuchsjager MH, Shukla-Dave A, Hricak H, Wang L, Touijer K, Donohue JF, et al. Magnetic resonance imaging in the prediction of biochemical recurrence of prostate cancer after radical prostatectomy. BJU international. [Evaluation Studies Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. 2009 Aug;104(3):315–20.Google Scholar
  31. 31.
    Kirac S, Duman Y, Cureklibatur I, Yuksel D, Nazli O, Gunaydin G, et al. Detection of metastatic bone lesions in patients with prostate carcinoma: 99Tcm-monoclonal antibody imaging. Nuclear medicine communications. Clinical Trial. 1997;18(10):968–73.Google Scholar
  32. 32.
    Cornud F, Rouanne M, Beuvon F, Eiss D, Flam T, Liberatore M, et al. Endorectal 3D T2-weighted 1 mm-slice thickness MRI for prostate cancer staging at 1.5Tesla: Should we reconsider the indirects signs of extracapsular extension according to the D’Amico tumor risk criteria? European journal of radiology. 2011 Aug 24.Google Scholar
  33. 33.
    Cornud F, Rouanne M, Beuvon F, Eiss D, Flam T, Liberatore M, et al. Endorectal 3D T2-Weighted 1 mm-slice thickness MRI for prostate cancer staging at 1.5 Tesla: should we reconsider the indirects signs of extracapsular extension according to the D’Amico tumor risk criteria? Eur J Radiology. 2011;in press.Google Scholar
  34. 34.
    Ren J, Huan Y, Wang H, Ge Y, Chang Y, Yin H, et al. Seminal vesicle invasion in prostate cancer: prediction with combined T2-weighted and diffusion-weighted MR imaging. Eur Radiol. 2009;19(10):2481–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63(4):387–95.PubMedCrossRefGoogle Scholar
  36. 36.
    •• Ahmed HU, Kirkham A, Arya M, Illing R, Freeman A, Allen C, et al. Is it time to consider a role for MRI before prostate biopsy? Nature reviews Clinical oncology. 2009 Apr;6(4):197–206. The use of MRI before a biopsy can select for biopsy patients with significant cancer that requires treatment. In those with normal MRI, unnecessary biopsies and detection of insignificant and hence unnecessary over-treatment could be avoided. CrossRefGoogle Scholar
  37. 37.
    • Haffner J, Lemaitre L, Puech P, Haber GP, Leroy X, Jones JS, 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 Mar 22. The strategy of targeted biopsies alone at prebiopsy MRI-suspicious areas is an attractive potential alternative to extended systematic biopsies for detection of significant prostate cancer. Google Scholar
  38. 38.
    Djavan B, Ravery V, Zlotta A, Dobronski P, Dobrovits M, Fakhari M, et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol. 2001;166(5):1679–83.PubMedCrossRefGoogle Scholar
  39. 39.
    • Hambrock T, Somford DM, Hoeks C, Bouwense SA, Huisman H, Yakar D, et al. Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. J Urol 2010;183(2):520–7. MRI-guided biopsy of tumor-suspicious regions is an accurate method to detect clinically significant prostate cancer in men with repeat negative biopsies and increased PSA. PubMedCrossRefGoogle Scholar
  40. 40.
    Cornud F, Schull A, Beuvon F, Peyromaure M, Barry Delongchamps N. TRUS-MRI image fusion before initial biopsy in patients with a normal DRE and a PSA level <10 ng/ml. European Congress of Radiology, Vienna, abstract2011.Google Scholar
  41. 41.
    Ukimura O. Evolution of precise and multimodal MRI and TRUS in detection and management of early prostate cancer. Expert review of medical devices [Review]. 2010;7(4):541–54.CrossRefGoogle Scholar
  42. 42.
    • Baumann M, Mozer P, Daanen V, Troccaz J. Prostate biopsy tracking with deformation estimation. Medical image analysis. 2011 May 17. Prostate deformation was estimated with elastic registration. The system was robust with only 17 registration failures out of 786 (2%) biopsy volumes acquired from 47 patients during biopsy sessions. The article emphasizes the accuracy of deformation, which is required during TRUS-MRI image fusion. Google Scholar
  43. 43.
    Tempany C, Straus S, Hata N, Haker S. MR-guided prostate interventions. J Magn Reson Imaging. 2008;27(2):356–67.PubMedCrossRefGoogle Scholar
  44. 44.
    Macura KJ, Stoianovici D. Advancements in magnetic resonance-guided robotic interventions in the prostate. Topics in magnetic resonance imaging: TMRI. [Research Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov’t Review]. 2008 Dec;19(6):297–304.Google Scholar
  45. 45.
    Descazeaud A, Peyromaure M, Vieillefond A, Bernard D, Zerbib M. Does transrectal MRI before radical prostatectomy modify the operative technique to decrease the positive margin rate? Prog Urol. 2006;16(5):564–7.PubMedGoogle Scholar
  46. 46.
    • Sartor AO, Hricak H, Wheeler TM, Coleman J, Penson DF, Carroll PR, et al. Evaluating localized prostate cancer and identifying candidates for focal therapy. Urology. 2008 Dec;72(6 Suppl):S12–24. The article refines the definition of the low-risk tumor with an adjustment of D’Amico criteria and inclusion of MRI findings. PubMedCrossRefGoogle Scholar
  47. 47.
    Tofts PS, Brix G, Buckley DL, Evelhoch JL, Henderson E, Knopp MV, et al. Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging. 1999;10(3):223–32.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • F. Cornud
    • 1
    Email author
  • N. B. Delongchamps
    • 2
  • P. Mozer
    • 3
  • F. Beuvon
    • 4
  • A. Schull
    • 1
  • N. Muradyan
    • 5
  • M. Peyromaure
    • 2
  1. 1.Service de Radiologie, Hôpital CochinParisFrance
  2. 2.Department of UrologyHôpital CochinParisFrance
  3. 3.Department of UrologyHôpital Pitié-SalpétrièreParisFrance
  4. 4.Department of PathologyHôpital CochinParisFrance
  5. 5.iCAD IncNashuaUSA

Personalised recommendations