Integrating MRI for the diagnosis of prostate cancer

Caroline M. Moore, Samir S. Taneja

We review recent developments in prostate MRI for prostate cancer diagnosis. Large series have strengthened the case for the use of MRI prior to subsequent biopsy to maximize the detection of clinically significant disease, and reduce the detection of clinically insignificant disease. This has effectively moved the discussion on from whether MRI is useful in prostate cancer detection to how best to use it, and at which time point. The Prostate Imaging- Reporting And Data System (PIRADS) group have published a second version of the PIRADS criteria for prostate MRI, covering acquisition, interpretation, and reporting both for clinical practice and data collection for research.There is debate about the commonly used and more prescriptive PIRADS system versus the less prescriptive systems based on overall clinical impression of clinically significant disease (e.g. Likert or simplified quantum scoring). Studies suggest that the Likert or simplified quantum scoring approach may outperform PIRADSv2. Published data are conflicting on whether software-assisted fusion of MRI lesions to ultrasound used at biopsy is more effective than visual registration by a trained operator. The use of prostate MRI is increasing worldwide, and the debate now focuses on how best to use it to optimize the detection of clinically significant disease.