Current Role of Magnetic Resonance Imaging in the Screening, Diagnosis, and Treatment of Prostate Cancer

Prostate cancer is the most common cancer in men. Diagnosis of prostate cancer poses a significant challenge, due to several different key parameters that need to be evaluated, such as age, history of prostate specific antigen (PSA), clinical examination and more recently magnetic resonance imaging (MRI). The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mp-MRI) of the prostate has been identified as a test that could alleviate these diagnostic errors. Before prostate cancer treatment pathological confirmation is mandatory. Prostate biopsy is an invasive procedure with rare but not negligible potential complications. There are several methods of prostate biopsy of which most common are systemic or planar prostate biopsy and cognitive or targeted MRI-guided prostate biopsy. Multiparametric MRI has demonstrated better accuracy and reproducibility in detecting, locating and evaluating prostate cancer and also sparing some men unnecessary biopsies. Recent studies have shown a mpMRI benefit for better procedure planning regarding prostate cancer location, extent of disease and length of the urethra. There are still some challenges ahead, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. According to the latest urological clinical guidelines mpMRI became fundamental tool in management of prostate cancer. The aim of this study is to give a brief insight in use of mpMRI in prostate cancer diagnosis and treatment.
Rak prostate najčešći je karcinom u muškaraca. Dijagnoza raka prostate predstavlja značajan izazov zbog nekoliko različitih ključnih parametara koje je potrebno procijeniti, kao što su dob, povijest prostata specifičnog antigena (PSA), klinički pregled i u novije vrijeme multiparametrijski MRI (mp-MRI). Trenutna dijagnostika raka prostate rezultirala je prekomjernom dijagnostikom i liječenjem, kao i poddijagnozom i propuštenom dijagnozom kod mnogih muškaraca. Multiparametrijski MRI prostate identificiran je kao test koji bi mogao ublažiti ove pogreške. Prije liječenja raka prostate obavezna je patološka potvrda. Biopsija prostate je invazivan postupak s rijetkim, ali ne i zanemarivim potencijalnim komplikacijama. Postoji nekoliko metoda biopsije prostate od kojih su najčešće sistemska ili planarna biopsija prostate i kognitivna ili ciljana biopsija prostate vođena MRI-om. Mp-MRI pokazao je bolju točnost i reproducibilnost u otkrivanju, lociranju i procjeni raka prostate, a također je poštedio neke muškarace nepotrebne biopsije. Nedavne studije pokazale su korist mpMRI-e za bolje planiranje zahvata s podacima o lokaciji raka prostate, opsegu bolesti i duljini uretre. Pred nama su još neki izazovi, poput osiguravanja visokokvalitetne izvedbe i izvješćivanja o mpMRI-u te osiguravanja da je ovaj dijagnostički put isplativ. Prema najnovijim urološkim kliničkim smjernicama mpMRI je postao temeljni alat u liječenju raka prostate. Cilj ove studije je dati kratak uvid u upotrebu mpMRI-e u dijagnostici i liječenju raka prostate.