Multiparametric MRI of the Prostate Gland
MRI has been used in New Zealand for more than 25 years for the noninvasive assessment of the prostate gland and adjacent pelvic organs. The initial application of MRI centred on local pelvic staging in patients with biopsy proven cancer.
More recent advances in hardware and software have led to the development of multiparametric MRI (mpMRI). The mpMRI technology combines anatomic assessment with functional and physiological assessment that includes diffusion weighted imaging (DWI) and the derivative apparent diffusion coefficient (ADC) maps, and dynamic contrast enhanced (DCE) MRI.
mpMRI has substantially increased the diagnostic capability for the assessment of prostate cancer. Specifically, the detection of clinically significant cancer is improved by mpMRI, and mpMRI provides increased confidence in the diagnosis and management of benign disease and dormant prostatic malignancy. Research has demonstrated that mpMRI has a high negative predictive value for clinically significant prostate cancer.
The clinical indications for mpMRI include not only locoregional staging of biopsy documented prostate cancer, but also the following applications:
1.Progressive rise in PSA in the context of negative transrectal or transperineal biopsy.
2.Localization of tumour prior to biopsy.
3.Localization of tumour prior to nonoperative therapy.
4.Imaging guidance for targeted biopsy.
5.Adjunct to biopsy and the other clinical parameters that are employed at initial risk stratificaton prior to the commencement of Active Surveillance of low grade prostate cancer.
6.Monitoring of patients who have low risk disease and are being managed by Active Surveillance.
7.Investigation of posttreatment biochemical failure for the detection of locally recurrent disease.
