Multiparametric MRI (mpMRI) has been the biggest gamechanger in the prostate cancer world for the past 15 years. It has revolutionized not only the detection prostate cancer (PCa), but it can actually fine tune the diagnosis, treatment plan, and even the treatment itself. Traditionally, almost all aspects of PCa were within the specialty of urology, but as urologists caught on to the immense value of MRI, an enormous amount of research and development was poured into technological devices such as fusion guidance, designed in an effort to put MRI in the hands of urologists. However, one does not have to be a purist to figure out that there is simply no substitute for mpMRI and its variety of uses.

The valuable uses of mpMRI

There are currently eight key mpMRI uses, each of which offers immense value to men suspected of having PCa, or already diagnosed with it. Here is a brief description of each:

1. Assessing need for a biopsy – A man who has an abnormal PSA or DRE but has not yet had a biopsy may be safely able to avoid a biopsy.^[i]
2. Pre-biopsy risk stratification – Thanks to the PI-RADS score system, mpMRI provides advance knowledge of the risk level of a suspicious area in the prostate. This gives important clues such as need for genomic testing for aggressive disease.
3. Evaluating patients who had a previous negative biopsy – An example of this is a man whose PSA has continued to rise in spite of an earlier negative biopsy (or even more than one negative biopsy). Since conventional systematic ultrasound-guided biopsies can miss PCa 30% or more of the time, mpMRI may detect significant PCa that was missed by biopsy needles.
4. Guidance for needle biopsies – Only a needle biopsy can offer definitive evidence of PCa, since the cells in the needle sample can be analyzed under a microscope. Thanks to real-time MRI guidance, a minimum number of needles targeted to the area where the most aggressive cells are likely to be can result in the maximum diagnostic accuracy. This allows treatment to be designed to tackle the most dangerous cells.
5. Staging procedures – Stage refers to the location of PCa activity within the gland, at the margins, beyond the gland, and in lymph nodes. Imaging done on a powerful 3T magnet can reveal the extent of the disease within the gland (localized) as well as early local or regional spread. It is
   essential to ascertain if a man’s PCa I still contained in the gland, especially if the patient is considering a radical treatment.
6. Treatment planning –Treatment options range from Active Surveillance to focal therapy to radical treatment by surgery or radiation. The main principle is, match the therapy to the cancer. mpMRI excels at mapping the cancer and sensing its aggression level. In addition to many other factors (age, family history, PSA, tumor stage, Gleason grade, etc.) mpMRI rounds out a portrait of a patient’s disease in order to facilitate the treatment plan.
7. Confirming treatment success – Of course, this is important for any treatment, but now that focal therapies are a standard-of-care option, using mpMRI as treatment follow-up immediately as well as at prescribed intervals offers assurance that the treatment was successful.
8. Monitoring Active Surveillance (AS) – Men who are on AS must periodically check in with their bodies to ensure their PCa has not begun to spread or progress to a higher level of aggression. mpMRI scans are a safe, noninvasive way to keep an eye on a patient’s tumor activity.

When it comes to prostate cancer, it may well be that today’s research will generate tomorrow’s additional uses for mpMRI. For now, mpMRI serves the needs of PCa men at any point in the prostate cancer journey.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32401-1/fulltext

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.