THE CURRENT ROLE OF MULTIPARAMETRIC MRI IN THE DIAGNOSIS OF PROSTATE CANCER: A LITERATURE REVIEW

Abstract

Relevance: Multiparametric MRI (mpMRI) is one of the main methods for diagnosing prostate cancer (PCa). Although mpMRI has been adopted into routine urological and oncological practice in a few short years, there are conflicting views on the timing of mpMRI. The purpose was to study the diagnostic value and role of mpMRI at the stages of diagnosis of prostate cancer. Methods: The article reviews the literature on the use of mpMRI in diagnosing prostate cancer in the framework of traditional clinical approaches. Results: current national guidelines in Europe emphasize the value of mpMRI in diagnosing patients with suspected PCa. The rationale for using mpMRI in selecting patients with suspected PCa who should and should not be biopsied and selecting areas of the prostate for biopsy is compelling. The evidence base, including level 1 studies, is overwhelming, as are arguments for patient benefit in avoiding biopsy or overdiagnosis of clinically insignificant cancer. Conclusion: Patients considering biopsy start to realize that mpMRI imaging can avoid biopsy in some cases and make it more targeted in others. For obvious reasons, these patients will seek to avoid the risk of biopsy or minimize the risk with fewer biopsy specimens. Switching from “standard” SB to TB judiciously and selectively augmented with BD using a two-stage risk assessment offers the best compromise to reduce biopsy rates and reduce overdiagnosis of cnPCa while minimizing the chances of missing clinically significant cancer. Evidence that it is possible to avoid SB altogether, even in the era of mpMRI before biopsy, is weak. This provides grounds for searching for new methods for diagnosing clinically significant cancer using mpMRI