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  • Review Article
  • Published:

Multiparametric MRI in prostate cancer management

Nature Reviews Clinical Oncology volume 11, pages 346–353 (2014)Cite this article

Subjects

Key Points

  • T2-weighed MRI allows anatomical visualization of both the transitional and peripheral zones of the prostate, where 30% and 70% of tumours are located, respectively

  • A delay of at least 6–10 weeks after a biopsy procedure is recommended before obtaining MRI of the prostate to allow residual haemorrhage to resolve

  • The addition of diffusion-weighted (DW) MRI significantly improves the accuracy of prostate tumour volume measurements when compared with T2-weighted MRI alone

  • There is a significant negative correlation between tumour apparent diffusion coefficient (ADC) values and Gleason scores, suggesting that ADC values are useful in predicting the aggressiveness of tumours

  • Dynamic contrast-enhanced MRI provides an assessment of perfusion and vascular permeability of the tumour; semiquantitative parameters in this approach (peak enhancement and washout gradient) are associated with tumour aggressiveness

  • MR spectroscopy compares the metabolic profiles of cancer cells with those of normal cells; increased levels of choline and high choline:citrate ratios can identify different types and grades of tumours

Abstract

Prostate cancer is the second most common cancer in men worldwide. The clinical behaviour of prostate cancer ranges from low-grade indolent tumours that never develop into clinically significant disease to aggressive, invasive tumours that may progress rapidly to metastatic disease and death. Therefore, there is an urgent clinical need to detect high-grade cancers and to differentiate them from the indolent, slow-growing tumours. Conventional methods of cancer detection—such as levels of prostate-specific antigen (PSA) in serum, digital rectal examination, and random biopsies—are limited in their sensitivity, specificity, or both. The combination of conventional anatomical MRI and functional magnet resonance sequences—known as multiparametric MRI (mp-MRI)—is emerging as an accurate tool for identifying clinically relevant tumours owing to its ability to localize them. In this Review, we discuss the value of mp-MRI in localized and metastatic prostate cancer, highlighting its role in the detection, staging, and treatment planning of prostate cancer.

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Figure 1: A 61-year-old man with serum PSA of 23.85 ng/ml.
Figure 2: A 59-year-old man with serum PSA of 24.7 ng/ml.
Figure 3: Curve types representing enhancement patterns on DCE–MRI.
Figure 4: Flowchart showing the utility of mp-MRI in various clinical scenarios of prostate cancer.

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Acknowledgements

The authors would like to thank the NIH intramural funding programme for financial support.

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Authors and Affiliations

  1. Molecular Pharmacology Section, Medical Oncology Branch, National Cancer Institute, 10 Center Drive, MSC 1182 Building 10, Bethesda, 20892-1088, MD, USA

    Linda M. Johnson

  2. Molecular Imaging Program, National Cancer Institute, 10 Center Drive, MSC 1182 Building 10, Bethesda, 20892-1088, MD, USA

    Baris Turkbey & Peter L. Choyke

  3. Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, 10 Center Drive, MSC 1182 Building 10, Bethesda, 20892-1088, MD, USA

    William D. Figg

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L.M.J. researched data and wrote the article. L.M.J., B.T., W.D.F. and P.L.C. made a substantial contribution to the discussion of the content. All authors reviewed and edited the manuscript before submission and after peer review.

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Correspondence to Baris Turkbey.

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Johnson, L., Turkbey, B., Figg, W. et al. Multiparametric MRI in prostate cancer management. Nat Rev Clin Oncol 11, 346–353 (2014). https://doi.org/10.1038/nrclinonc.2014.69

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