Current status of MRI for the diagnosis, staging and prognosis of prostate cancer: implications for focal therapy and active surveillance

PURPOSE OF REVIEW: To review the current status of MRI techniques in identification of organ-confined prostate cancer with a focus on their implication for focal therapy and active surveillance. RECENT FINDINGS: MRI is currently focusing on intraprostatic prostate cancer identification and at 1.5T, it provides excellent imaging of the whole gland including the challenging anterior part. Improvements in accuracy for cancer detection and volume estimation result from dynamic contrast-enhanced and diffusion-weighted MRI sequences. 3T MRI might improve cancer identification. Histological correlations showed high sensitivity and specificity for significant volume cancers larger than 0.5 cm3. Important knowledge on modelling of cancer morphology such as zone of origin and intraprostatic patterns of spread at histopathology was made available for imaging interpretation and treatment planning decision. MRI results allow focused use of biopsy which led to better cancer characterization such as extent and grade. Ongoing focal therapy protocols and active surveillance treatments should benefit from these imaging advances. SUMMARY: At present, high-resolution MRI with pelvic coil appears to offer the most readily available and useful imaging. Future studies should work towards helping define standard, reproducible approaches to imaging and image reporting for research and clinical practice.