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The use of multimodality magnetic resonance imaging ( MRI ) may improve the diagnosis and treatment of prostate cancer.

Multimodality MRI is the use of high-resolution image acquisition, dynamic contrast-enhanced imaging (DCE) to evaluate the vascular permeability, diffusion-weighted imaging (DWI) to study the vascular permeability and spectroscopy to evaluate the choline-creatine / citrate ratio.

In a study from Futterer, the use of dynamic contrast-enhanced MRI imaging and 3D MRI spectroscopic imaging significantly improved accuracy in prostate cancer localization.

In another study with 68 men with repeat negative transrectal ultrasound guided prostate biopsies, Hambrock, et al. performed MRI -guided prostate biopsy and found prostate cancer in 59% of the patients. In 57% of them the tumor was anteriorly located.

The analysis of DWI is related to the Gleason grade and may predict the tumor aggressiveness providing the clinician the necessary information to spare high-risk patients from active surveillance protocols.

Multimodality MRI may also help in local staging of prostate cancer and this information may be useful when selecting good candidates for nerve sparing radical prostatectomy. The evaluation of extracapsullar extension by MRI has an 87% sensitivity and 96% specificity.

Ferumoxtran is useful in patients with high risk of nodal involvement prior to surgery or radiotherapy, or in patients with tumor recurrence to distinguish between local or distant failure.

Source: UroToday