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The emerging role of diffusion-weighted MRI in prostate cancer management

Nature Reviews Urology volume 9, pages 94–101 (2012)Cite this article

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Abstract

A significant amount of research has focused on the role of diffusion-weighted MRI (DW-MRI) in the management of patients with prostate cancer. Although uncertainties remain, a clearer picture of where this technique fits into clinical practice is now available. A combination of DW-MRI and T2-weighted MRI (T2W-MRI) demonstrates improved accuracy for lesion detection and localization compared with T2W-MRI alone, and has been suggested as a tool to guide tissue biopsy. DW-MRI could also have roles in active surveillance, evaluating treatment efficacy, and predicting disease recurrence. Furthermore, DW-MRI offers the exciting possibility of gathering information about tumor characteristics and aggressiveness in a noninvasive manner. Validation in large prospective multicenter trials is critical if this technique is to be integrated into current management algorithms for prostate cancer.

Key Points

  • Adding diffusion-weighted MRI (DW-MRI) to traditional T2-weighted imaging improves the accuracy of prostate cancer detection and could be a useful tool before rebiopsy to increase yield and accuracy

  • During prostate cancer staging, DW-MRI can enhance the detection of invasion into seminal vesicles and the bladder neck, as well as regional lymph node invasion and distant metastases to bone

  • DW-MRI shows promise as a noninvasive biomarker of tumor characteristics, such as Gleason grade, cellular differentiation, tumor cell density, and tumor aggressiveness

  • DW-MRI has potential roles in the management of patients under active surveillance, and in monitoring treatment efficacy and disease recurrence in the follow-up period after treatment

  • Advancements in the processing and analysis of data obtained from DW-MRI might lead to improved characterization of tumor lesions

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Figure 1: An example of an MRI image set and ADC map for a patient with prostate cancer.
Figure 2: Advanced prostate cancer with bone metastases and bladder invasion.

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Acknowledgements

The authors would like to thank the NIHR: Cambridge Biomedical Research Centre, the University of Cambridge, Hutchison Whampoa Limited, the Cambridge Experimental Cancer Medicine Centre, ACT, Cancer Research UK, and the Royal College of Surgeons of England for funding support.

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Authors and Affiliations

  1. Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 1QQ, Cambridge, UK

    Edward M. Lawrence, Andrew N. Priest & Evis Sala

  2. Department of Urology, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 1QQ, Cambridge, UK

    Vincent J. Gnanapragasam

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E. M. Lawrence and E. Sala researched the data and contributed towards writing the article, along with V. Gnanaprogasam. All authors contributed substantially to discussions of article content, as well as reviewing the editing the article prior to submission.

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Correspondence to Edward M. Lawrence.

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Lawrence, E., Gnanapragasam, V., Priest, A. et al. The emerging role of diffusion-weighted MRI in prostate cancer management. Nat Rev Urol 9, 94–101 (2012). https://doi.org/10.1038/nrurol.2011.222

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