Prostate MRI can reduce overdiagnosis and overtreatment of prostate cancer

Academic Radiology
Andrew B Rosenkrantz, Samir S Taneja

Abstract

The contemporary management of prostate cancer (PCa) has been criticized as fostering overdetection and overtreatment of indolent disease. In particular, the historical inability to identify those men with an elevated PSA who truly warrant biopsy, and, for those needing biopsy, to localize aggressive tumors within the prostate, has contributed to suboptimal diagnosis and treatment strategies. This article describes how modern multi-parametric MRI of the prostate addresses such challenges and reduces both overdiagnosis and overtreatment. The central role of diffusion-weighted imaging (DWI) in contributing to MRI's current impact is described. Prostate MRI incorporating DWI achieves higher sensitivity than standard systematic biopsy for intermediate-to-high risk tumor, while having lower sensitivity for low-grade tumors that are unlikely to impact longevity. Particular applications of prostate MRI that are explored include selection of a subset of men with clinical suspicion of PCa to undergo biopsy as well as reliable confirmation of only low-risk disease in active surveillance patients. Various challenges to redefining the standard of care to incorporate solely MRI-targeted cores, without concomitant standard systematic cores, ...Continue Reading

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Citations

Jun 24, 2015·Academic Radiology·Saurabh Jha
Jan 24, 2019·International Urology and Nephrology·Michael WangLee Ponsky
Aug 20, 2019·Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine·Matthew S DavenportMorand Piert
Oct 16, 2021·Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine·Dominik F BauerFrank G Zöllner

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