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Is it time to consider a role for MRI before prostate biopsy?

Nature Reviews Clinical Oncology volume 6, pages 197–206 (2009)Cite this article

Abstract

The use of MRI in prostate cancer management is controversial and current guidelines underplay its role. Technological advances over the past 5 years, however, demand a re-evaluation of this position. In this article, we propose an increased use of MRI, not only in those with a diagnosis of prostate cancer but also for men before a prostate biopsy. The use of MRI before a biopsy can serve as a triage test in men with raised serum prostate-specific antigen levels, in order to select those for biopsy with significant cancer that requires treatment. This strategy could avoid biopsy, and hence unnecessary treatment, in those with no disease or insignificant cancer. In addition, avoidance of postbiopsy artifact caused by hemorrhage will lead to better local staging accuracy, while determining more accurately the disease burden. This approach could improve risk stratification by selecting those who require adjuvant therapy or dose escalation. Furthermore, MRI evaluation of cancer burden could be important in active surveillance regimens to select those needing intervention.

Key Points

  • The role of MRI in prostate cancer management is controversial; most guidelines recommend its use only in high-risk patients on the basis of evidence that used early-generation machines rather than up-to-date data

  • The use of spectroscopy, dynamic contrast enhancement and diffusion weighting in combination with traditional T2-weighted scans increases the accuracy of MRI to detect and stage prostate cancer

  • If multisequence MRI was applied in the prebiopsy setting to overcome biopsy artifact, it could potentially increase the detection of significant prostate cancer, and decrease the diagnosis of indolent disease

  • Such scans could guide traditional therapy such as surgery and radiotherapy and select those men with high-risk disease that require dose escalation, and those with a low burden of disease

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Figure 1: Chronological sequence of T2-weighted MR axial images (1.5 Tesla) showing sequence of changes in prostate after needle insertion.
Figure 2: The added value of diffusion weighted scans could aid in the detection of anterior tumors that are not visible with other MRI modalities.
Figure 3: Combining different MRI modalities (multisequence MRI) might confer greater accuracy and confidence of diagnosis in cancer detection.
Figure 4: Extracapsular extension.

References

  1. Cookson, M., Thompson, I. & Thrasher, B. American Urological Association—AUA Update: Guidelines for Prostate Cancer (2006).

  2. Heidenreich, A. et al. Guidelines on Prostate Cancer. European Association of Urology, Update March (2007).

  3. Ahmed, H. U. et al. Will focal therapy become a standard of care for men with localized prostate cancer? Nat. Clin. Pract. Oncol. 4, 632–642 (2007).

    Article  PubMed  Google Scholar 

  4. White, S. et al. Prostate cancer: effect of postbiopsy hemorrhage on interpretation of MR images. Radiology 195, 385–390 (1995).

    Article  CAS  PubMed  Google Scholar 

  5. Saad, F. et al. Canadian surgical wait times (SWAT) initiative. Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature. Can. J. Urol. 13 (Suppl. 3), 16–24 (2006).

    PubMed  Google Scholar 

  6. Vickers, A. J., Bianco, F. J. Jr, Boorjian, S., Scardino, P. T. & Eastham, J. A. Does a delay between diagnosis and radical prostatectomy increase the risk of disease recurrence? Cancer 106, 576–580 (2006).

    Article  PubMed  Google Scholar 

  7. Department of Health, UK. Tackling hospital waiting: the 18 week patient pathway. An implementation framework. [online 10 May 2006], http://www.pfc.org.uk/files/18_weeks_implimentation.pdf (accessed 5 February 2009).

  8. Djavan, B. et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J. Urol. 166, 1679–1683 (2001).

    Article  CAS  PubMed  Google Scholar 

  9. Jermal, A. et al. Cancer statistics, 2006. CA Cancer J. Clin. 56, 106–130 (2006).

    Article  Google Scholar 

  10. McNeal, J. E., Redwine, E. A., Freiha, F. S. & Stamey, T. A. Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am. J. Surg. Pathol. 12, 897–906 (1988).

    Article  CAS  PubMed  Google Scholar 

  11. Kirkham, A. P., Emberton, M. & Allen, C. How good is MRI at detecting and characterising cancer within the prostate? Eur. Urol. 50, 1163–1174 (2006).

    Article  PubMed  Google Scholar 

  12. Kozlowski, P. et al. Combined diffusion-weighted and dynamic contrast-enhanced MRI for prostate cancer diagnosis—correlation with biopsy and histopathology. J. Magn. Reson. Imaging 2, 108–113 (2006).

    Article  Google Scholar 

  13. Hricak, H. MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer. Br. J. Radiol. 78, S103–S111 (2005).

    Article  PubMed  Google Scholar 

  14. Ikonen, S. et al. Magnetic resonance imaging of clinically localized prostatic cancer. J. Urol. 159, 915–919 (1998).

    Article  CAS  PubMed  Google Scholar 

  15. Zakian, K. L. et al. Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy. Radiology 234, 804–814 (2005).

    Article  PubMed  Google Scholar 

  16. Harlan, S. R. et al. Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: results from CaPSURE. J. Urol. 170, 1804–1807 (2003).

    Article  PubMed  Google Scholar 

  17. Furuno, T. et al. Difference of cancer core distribution between first and repeat biopsy: in patients diagnosed by extensive transperineal ultrasound guided template prostate biopsy. Prostate 58, 76–81 (2004).

    Article  PubMed  Google Scholar 

  18. Dhingsa, R. et al. Prostate cancer localization with endorectal MR imaging and MR spectroscopic imaging: effect of clinical data on reader accuracy. Radiology 230, 215–220 (2004).

    Article  PubMed  Google Scholar 

  19. Muramoto, S. et al. Differentiation of prostate cancer from benign prostate hypertrophy using dual-echo dynamic contrast MR imaging. Eur. J. Radiol. 44, 52–58 (2002).

    Article  PubMed  Google Scholar 

  20. Futterer, J. J. et al. Standardized threshold approach using three-dimensional proton magnetic resonance spectroscopic imaging in prostate cancer localization of the entire prostate. Invest. Radiol. 42, 116–122 (2007).

    Article  PubMed  Google Scholar 

  21. Hara, N., Okuizumi, M., Koike, H., Kawaguchi, M. & Bilim, V. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a useful modality for the precise detection and staging of early prostate cancer. Prostate 62, 140–147 (2005).

    Article  PubMed  Google Scholar 

  22. Kumar, V. et al. Transrectal ultrasound-guided biopsy of prostate voxels identified as suspicious of malignancy on three-dimensional (1)H MR spectroscopic imaging in patients with abnormal digital rectal examination or raised prostate specific antigen level of 4–10 ng/ml. NMR Biomed. 20, 11–20 (2007).

    Article  PubMed  Google Scholar 

  23. Villers, A. et al. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J. Urol. 176, 2432–2437 (2006).

    Article  PubMed  Google Scholar 

  24. Ahmed, H. U. et al. Re: Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. A. Villers, P. Puech, D. Mouton, X. Leroy, C. Ballereau, L. Lemaitre, J Urol 2006; 176, 2432–2437 J. Urol. 177, 2395 (2007).

    Article  Google Scholar 

  25. Sato, C. et al. Differentiation of noncancerous tissue and cancer lesions by apparent diffusion coefficient values in transition and peripheral zones of the prostate. J. Magn. Reson. Imaging 21, 258–262 (2005).

    Article  PubMed  Google Scholar 

  26. Desouza, N. M., Reinsberg, S. A., Scurr, E. D., Brewster, J. M. & Payne, G. S. Magnetic resonance imaging in prostate cancer: value of apparent diffusion coefficients for identifying malignant nodules. Br. J. Radiol. 80, 90–95 (2007).

    Article  CAS  PubMed  Google Scholar 

  27. Shimofusa, R. et al. Diffusion-weighted imaging of prostate cancer. J. Comput. Assist. Tomogr. 29, 149–153 (2005).

    Article  PubMed  Google Scholar 

  28. Kumar, V. et al. Correlation between metabolite ratios and ADC values of prostate in men with increased PSA level. Magn. Reson. Imaging 24, 541–548 (2006).

    Article  CAS  PubMed  Google Scholar 

  29. van Dorsten, F. A. et al. Combined quantitative dynamic contrast-enhanced MR imaging and (1)H MR spectroscopic imaging of human prostate cancer. J. Magn. Reson. Imaging 20, 279–287 (2004).

    Article  PubMed  Google Scholar 

  30. Albertsen, P. C., Hanley, J. A. & Fine, J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 293, 2095–2101 (2005).

    Article  CAS  PubMed  Google Scholar 

  31. Tanimoto, A., Nakashima, J., Kohno, H., Shinmoto, H. & Kuribayashi, S. Prostate cancer screening: the clinical value of diffusion-weighted imaging and dynamic MR imaging in combination with T2-weighted imaging. J. Magn. Reson. Imaging 25, 146–152 (2007).

    Article  PubMed  Google Scholar 

  32. Cookson, M. S., Fleshner, N. E., Soloway, S. M. & Fair, W. R. Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J. Urol. 157, 559–562 (1997).

    Article  CAS  PubMed  Google Scholar 

  33. Freedland, S. J. et al. Percent of prostate needle biopsy cores with cancer is significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J. Urol. 169, 2136–2141 (2003).

    Article  PubMed  Google Scholar 

  34. Antunes, A. A. et al. The percentage of positive biopsy cores as a predictor of disease recurrence in patients with prostate cancer treated with radical prostatectomy. BJU Int. 96, 1258–1263 (2005).

    Article  PubMed  Google Scholar 

  35. Kumar, V. et al Potential of 3D 1H MRSI localization of prostate cancer to direct TRUS guided biopsy in patients with PSA 4–10 ng/mL. Proc. Intl Soc. Mag. Reson. Med. 14, 1788 (2006).

    Google Scholar 

  36. Kulkarni, G. S. et al. Evidence for a biopsy derived grade artifact among larger prostate glands. J. Urol. 175, 505–509 (2006).

    Article  PubMed  Google Scholar 

  37. Ikonen, S. et al. Magnetic resonance imaging of prostatic cancer: does detection vary between high and low gleason score tumors? Prostate 43, 43–48 (2000).

    Article  CAS  PubMed  Google Scholar 

  38. Mazahari, Y., Koutcher, J. A., Shukla-Dave, A. & Hricak, H. Imaging and multi-parametric analysis of cancerous tissue (IMPACT): Prostate Cancer (PCa). Proc. Intl Soc. Mag. Reson. Med. 14, 3497 (2003).

    Google Scholar 

  39. Rouvière, O. et al. Characterization of time-enhancement curves of benign and malignant prostate tissue at dynamic MR imaging. Eur. Radiol. 13, 931–942 (2003).

    Article  PubMed  Google Scholar 

  40. Girouin, N. et al. Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur. Radiol. 17, 1498–1509 (2007).

    Article  PubMed  Google Scholar 

  41. Cantor, S. B., Volk, R. J., Cass, A. R., Gilani, J. & Spann, S. J. Psychological benefits of prostate cancer screening: the role of reassurance. Health Expect. 5, 104–113 (2002).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wefer, A. E. et al. Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J. Urol. 164, 400–404 (2000).

    Article  CAS  PubMed  Google Scholar 

  43. Beyersdorff, D. et al. Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: value of MR imaging. Radiology 224, 701–706 (2002).

    Article  PubMed  Google Scholar 

  44. Prando, A., Kurhanewicz, J., Borges, A. P., Oliveira, E. M. Jr. & Figueiredo, E. Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: early experience. Radiology 236, 903–910 (2005).

    Article  PubMed  Google Scholar 

  45. Comet-Batlle, J., Vilanova-Busquets, J. C., Saladie-Roig, J. M., Gelabert-Mas, A. & Barcelo-Vidal, C. The value of endorectal MRI in the early diagnosis of prostate cancer. Eur. Urol. 44, 201–207 (2003).

    Article  CAS  PubMed  Google Scholar 

  46. Nijs, H. G., Essink-Bot, M. L., DeKoning, H. J., Kirkels, W. J. & Schroder, F. H. Why do men refuse or attend population-based screening for prostate cancer? J. Public Health Med. 22, 312–316 (2000).

    Article  CAS  PubMed  Google Scholar 

  47. Mkinen, T., Auvinen A, Hakama, M., Stenman, U. H. & Tammela, T. L. Acceptability and complications of prostate biopsy in population-based PSA screening versus routine clinical practice: a prospective, controlled study. Urology 60, 846–850 (2002).

    Article  PubMed  Google Scholar 

  48. Bossuyt, P. M., Irwig, L., Craig, J. & Glasziou, P. Comparative accuracy: assessing new tests against existing diagnostic pathways. BMJ 332, 1089–1092 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Morgan, D., Ahmed, H. U., Emberton, M., Hawkes, D. & Barratt, D. Registration of preoperative MR to intraoperative ultrasound images for guiding minimally invasive prostate interventions [Abstract]. Proc. Medical Image Understanding and Analysis (MIUA) 181–185 (2007).

  50. Singh, A. K. Initial clinical experience with real-time transrectal ultrasonography-magnetic resonance imaging fusion-guided prostate biopsy. BJU Int. 101, 841–845 (2008).

    Article  PubMed  Google Scholar 

  51. Hricak, H., Choyke, P. L., Eberhardt, S. C., Leibel, S. A. & Scardino, P. T. Imaging prostate cancer: a multidisciplinary perspective. Radiology 245, 28–53 (2007).

    Article  Google Scholar 

  52. Fütterer, J. J. MR imaging in local staging of prostate cancer. Eur. J. Radiol. 63, 328–334 (2007).

    Article  PubMed  Google Scholar 

  53. Rifkin, M. D. et al. Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. Results of a multi-institutional cooperative trial. N. Engl. J. Med. 323, 621–626 (1990).

    Article  CAS  PubMed  Google Scholar 

  54. Sonnad, S. S., Langlotz, C. P. & Schwartz, J. S. Accuracy of MR imaging for staging prostate cancer: a meta-analysis to examine the effect of technologic change. Acad. Radiol. 8, 149–157 (2001).

    Article  CAS  PubMed  Google Scholar 

  55. Engelbrecht, M. R. et al. Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur. Radiol. 12, 2294–2302 (2002).

    Article  PubMed  Google Scholar 

  56. Huch Boni, R. A. et al. Optimization of prostate carcinoma staging: comparison of imaging and clinical methods. Clin. Radiol. 50, 593–600 (1995).

    Article  CAS  PubMed  Google Scholar 

  57. Hering, F., Rist, M., Roth, J., Mihatsch, M. & Ruishauser, G. Does microinvasion of the capsule and/or micrometastases in regional lymph nodes influence disease-free survival after radical prostatectomy? Br. J. Urol. 66, 177–181 (1990).

    Article  CAS  PubMed  Google Scholar 

  58. Epstein, J. I., Partin, A. W., Sauvageot, J. & Walsh, P. C. Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am. J. Surg. Path. 20, 286–292 (1996).

    Article  CAS  PubMed  Google Scholar 

  59. Jager, G. J. et al. Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am. J. Roentgenol. 166, 845–852 (1996).

    Article  CAS  PubMed  Google Scholar 

  60. Wang, L. et al. Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to staging nomograms. Radiology 238, 597–603 (2006).

    Article  PubMed  Google Scholar 

  61. Wetter, A. et al. Combined MRI and MR spectroscopy of the prostate before radical prostatectomy. AJR Am. J. Roentgenol. 187, 724–730 (2006).

    Article  PubMed  Google Scholar 

  62. Jager, G. J. et al. Dynamic TurboFLASH subtraction technique for contrast-enhanced MR imaging of the prostate: correlation with histopathology. Radiology 203, 645–652 (1997).

    Article  CAS  PubMed  Google Scholar 

  63. Futterer, J. J. et al. Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. Radiology 237, 541–549 (2005).

    Article  PubMed  Google Scholar 

  64. Huch Boni, R. A. et al. Contrast-enhanced endorectal coil MRI in local staging of prostate carcinoma. J. Comput. Assist. Tomogr. 19, 232–237 (1995).

    Article  CAS  PubMed  Google Scholar 

  65. Lange, P. H. & Narayan, P. Understaging and undergrading of prostate cancer. Argument for postoperative radiation as adjuvant therapy. Urology 21, 113–118 (1983).

    Article  CAS  PubMed  Google Scholar 

  66. D'Amico, A. V. et al. Critical analysis of the ability of the endorectal coil magnetic resonance imaging scan to predict pathologic stage, margin status, and postoperative prostate-specific antigen failure in patients with clinically organ-confined prostate cancer. J. Clin. Oncol. 14, 1770–1777 (1996).

    Article  CAS  PubMed  Google Scholar 

  67. Cheng, G. C. et al. Clinical utility of endorectal MRI in determining PSA outcome for patients with biopsy Gleason score 7, PSA < or = 10, and clinically localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 55, 64–70 (2003).

    Article  PubMed  Google Scholar 

  68. D'Amico, A. V. et al. Endorectal magnetic resonance imaging as a predictor of biochemical outcome after radical prostatectomy in men with clinically localized prostate cancer. J. Urol. 164, 759–763 (2000).

    Article  CAS  PubMed  Google Scholar 

  69. Clarke, D. H. et al. The role of endorectal coil MRI in patient selection and treatment planning for prostate seed implants. Int. J. Radiat. Oncol. Biol. Phys. 52, 903–910 (2002).

    Article  PubMed  Google Scholar 

  70. Hricak, H. et al. The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy. Cancer 100, 2655–2663 (2004).

    Article  PubMed  Google Scholar 

  71. Coakley, F. V. et al. Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J. Urol. 168, 1032–1035 (2002).

    Article  PubMed  Google Scholar 

  72. Lee, S. E. et al. Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy. Urology 68, 137–141 (2006).

    Article  PubMed  Google Scholar 

  73. Coakley, F. V. et al. Blood loss during radical retropubic prostatectomy: relationship to morphologic features on preperative endorectal magnetic resonance imaging. Urology 59, 884–888 (2002).

    Article  PubMed  Google Scholar 

  74. Zietman, A. L. et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 294, 1233–1239 (2005).

    Article  CAS  PubMed  Google Scholar 

  75. Roach, M. 3rd, Faillace-Akazawa, P., Malfatti, C., Holland, J. & Hricak, H. Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for three-dimensional conformal radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 35, 1011–1018 (1996).

    Article  PubMed  Google Scholar 

  76. Rasch, C. et al. Definition of the prostate in CT and MRI: a multi-observer study. Int. J. Radiat. Oncol. Biol. Phys. 43, 57–66 (1999).

    Article  CAS  PubMed  Google Scholar 

  77. Steenbakkers, R. J. et al. Reduction of dose delivered to the rectum and bulb of the penis using MRI delineation for radiotherapy of the prostate. Int. J. Radiat. Oncol. Biol. Phys. 57, 1269–1279 (2003).

    Article  PubMed  Google Scholar 

  78. Villeirs, G. M. & De Meerleer, G. O. Magnetic resonance imaging (MRI) anatomy of the prostate and application of MRI in radiotherapy planning. Eur. J. Radiol. 63, 361–368 (2007).

    Article  PubMed  Google Scholar 

  79. Roach, M. 3rd. Is it time to change the standard of care from CT to MRI for defining the apex of the prostate to accomplish potency-sparing radiotherapy? Int. J. Radiat. Oncol. Biol. Phys. 61, 1–2 (2005).

    Article  PubMed  Google Scholar 

  80. McLaughlin, P. W. et al. Vessel-sparing prostate radiotherapy: dose limitation to critical erectile vascular structures (internal pudendal artery and corpus cavernosum) defined by MRI. Int. J. Radiat. Oncol. Biol. Phys. 61, 20–31 (2005).

    Article  PubMed  Google Scholar 

  81. Buyyounouski, M. K. et al. Intensity-modulated radiotherapy with MRI simulation to reduce doses received by erectile tissue during prostate cancer treatment. Int. J. Radiat. Oncol. Biol. Phys. 58, 743–749 (2004).

    Article  PubMed  Google Scholar 

  82. Mizowaki, T. et al. Towards integrating functional imaging in the treatment of prostate cancer with radiation: the registration of the MR spectroscopy imaging to ultrasound/CT images and its implementation in treatment planning. Int. J. Radiat. Oncol. Biol. Phys. 54, 1558–1564 (2002).

    Article  PubMed  Google Scholar 

  83. Huisman, H. J. et al. Prostate cancer: precision of integrating functional MR imaging with radiation therapy treatment by using fiducial gold markers. Radiology 236, 311–317 (2005).

    Article  PubMed  Google Scholar 

  84. Atalar, E. & Menard, C. MR-guided interventions for prostate cancer. Magn. Reson. Imaging Clin. N. Am. 13, 491–504 (2005).

    Article  PubMed  Google Scholar 

  85. Crawford, E. D. et al. Clinical staging of prostate cancer: a computer-simulated study of transperineal prostate biopsy. BJU Int. 96, 999–1004 (2005).

    Article  PubMed  Google Scholar 

  86. Satoh, T. et al. Cancer core distribution in patients diagnosed by extended transperineal prostate biopsy. Urology 66, 114–118 (2005).

    Article  PubMed  Google Scholar 

  87. Gosselaar, C, Roobol, M. J. & Schroder, F. H. Prevalence and characteristics of screen-detected prostate carcinomas at low prostate-specific antigen levels: aggressive or insignificant? BJU Int. 95, 231–237 (2005).

    Article  PubMed  Google Scholar 

  88. Lagerburg, V., Moerland, M. A., Lagendijk, J. J. & Battermann, J. J. Measurement of prostate rotation during insertion of needles for brachytherapy. Radiother. Oncol. 77, 318–323 (2005).

    Article  PubMed  Google Scholar 

  89. Sakr, W. A. et al. High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic adenocarcinoma between the ages of 20–69: an autopsy study of 249 cases. In Vivo 8, 439–443 (1994).

    CAS  PubMed  Google Scholar 

  90. Zhan, Y., Feldman, M., Tomaszeweski, J., Davatzikos, C. & Shen, D. Registering histological and MR images of prostate for image-based cancer detection. Med. Image Comput. Comput. Assist. Interv. Int. Conf. Med. Image Comput. Comput. Assist. Interv. 9, 620–628 (2006).

    Google Scholar 

  91. Miller, J., Perumalla, C. & Heap, G. Complications of transrectal versus transperineal prostate biopsy. ANZ J. Surg. 75, 48–50 (2005).

    Article  PubMed  Google Scholar 

  92. Carter, H. B. et al. Nonpalpable prostate cancer: detection with MR imaging. Radiology 178, 523–525 (1991).

    Article  CAS  PubMed  Google Scholar 

  93. Wise, A. M., Stamey, T. A., McNeal, J. E. & Clayton, J. L. Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 60, 264–269 (2002).

    Article  PubMed  Google Scholar 

  94. Klotz, L. Active surveillance for prostate cancer: for whom? J. Clin. Oncol. 23, 8165–8169 (2005).

    Article  PubMed  Google Scholar 

  95. Hardie, C. et al. Early outcomes of active surveillance for localized prostate cancer. BJU Int. 95, 956–960 (2005).

    Article  PubMed  Google Scholar 

  96. Kikuchi, E., Scardino, P. T., Wheeler, T. M., Slawin, K. M. & Ohori, M. Is tumor volume an independent prognostic factor in clinically localized prostate cancer? J. Urol. 172, 508–511 (2004).

    Article  PubMed  Google Scholar 

  97. Sengupta, S. et al. After radical retropubic prostatectomy 'insignificant' prostate cancer has a risk of progression similar to low-risk 'significant' cancer. BJU Int. 101, 170–174 (2008).

    Article  PubMed  Google Scholar 

  98. Shukla-Dave, A. et al. The utility of magnetic resonance imaging and spectroscopy for predicting insignificant prostate cancer: an initial analysis. BJU Int. 99, 786–793 (2007).

    Article  CAS  PubMed  Google Scholar 

  99. Health and Social Care Information Centre. Hospital Episode Statistics 2004–2005 Department of Health, United Kingdom, December (2005). http://www.hesonline.nhs.uk (accessed 1 August 2008).

  100. Abella, H. A. Lack of national diagnosis, care plan spurs call for action. Diagnostic Imaging 36–38 (2008) http://www.diagnosticimaging.com (accessed 1 January 2008).

  101. Miller, D. C., Gruber, S. B., Hollenbeck, B. K., Montie, J. E. & Wei, J. T. Incidence of initial local therapy among men with lower-risk prostate cancer in the United States. J. Natl Cancer Inst. 98, 1134–1141 (2006).

    Article  PubMed  Google Scholar 

  102. Cooperberg, M. R., Moul, J. W. & Carroll, P. The changing face of prostate cancer. J. Clin. Onc. 23, 8146–8151 (2005).

    Article  Google Scholar 

  103. Bill-Axelson, A. et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N. Engl. J. Med. 352, 1977–1984 (2005).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical and Interventional Sciences, University College London, UK

    Hashim U. Ahmed, Manit Arya & Mark Emberton

  2. University College London Hospitals NHS Foundation Trust, London, UK

    Alex Kirkham, Rowland Illing, Alex Freeman & Clare Allen

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  1. Hashim U. Ahmed
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Correspondence to Hashim U. Ahmed.

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Competing interests

HU Ahmed declared he receives research support and is a consultant/speakers bureau for Misonix/Focus Surgery, Steba Biotech and UKHIFU. He also receives research support from Advanced Medical Diagnostics, and is a consultant for Misonix/Focus Surgery and Steba Biotech. HU Ahmed is a stock holder for Prostate Mapping. M Emberton is a consultant for Misonix/Focus Surgery and is on the speakers bureau and receives research support from Advanced Medical Diagnostics, Misonix/Focus Surgery, Steba Biotech and UKHIFU. M Emberton is a stock holder for Prostate Mapping. RO Illing is a consultant for Misonix/Focus Surgery and receives research support/is on the speakers bureau for Misonix/Focus Surgery and UKHIFU. RO Illing is a stock holder for Prostate Mapping. C Allen is a stock holder for Prostate Mapping. The other authors declared no competing interests.

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Ahmed, H., Kirkham, A., Arya, M. et al. Is it time to consider a role for MRI before prostate biopsy?. Nat Rev Clin Oncol 6, 197–206 (2009). https://doi.org/10.1038/nrclinonc.2009.18

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