Role of MRI in the Risk Assessment of Primary Prostate Cancer

A successful paradigm shift toward personalized management strategies for patients with prostate cancer (PCa) is heavily dependent on the availability of noninvasive diagnostic tools capable of accurately establishing the true extent of disease at the time of diagnosis and estimating the risk of subsequent disease progression and related mortality. Although there is still considerable scope for improvement in its diagnostic, predictive, and prognostic capabilities, multiparametric prostate magnetic resonance imaging (MRI) is currently regarded as the imaging modality of choice for local staging of PCa. A negative MRI, that is, the absence of any MRI-visible intraprostatic lesion, has a high negative predictive value for the presence of clinically significant PCa and can substantiate the consideration of active surveillance as a preferred initial management approach. MRI-derived quantitative and semi-quantitative parameters can be utilized to noninvasively characterize MRI-visible prostate lesions and identify those patients who are most likely to benefit from radical treatment, and differentiate them from patients with benign or indolent prostate pathology that may also be visible on MRI. This literature review summarizes current strategies how MRI can be used to determine a tailored management strategy for an individual patient.