Faculty Bibliography

The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and consequent overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mpMRI) of the prostate has been identified as a test that could mitigate these diagnostic errors. The performance of mpMRI can vary depending on the population being studied, the execution of the MRI itself, the experience of the radiologist, whether additional biomarkers are considered and whether mpMRI-targeted biopsy is carried out alone or in addition to systematic biopsy. A number of challenges to implementation remain, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. Nevertheless, emerging clinical trial data support the adoption of this technology as part of the standard of care for the diagnosis of prostate cancer.

PURPOSE/OBJECTIVE:We update the prior AUA SOP for MRI of the prostate and summarize the available data about the technique and clinical use of MRI in the diagnosis and management of prostate cancer. This updated SOP provides practical recommendations for MRI use in the screening, diagnosis, staging, treatment, and surveillance of prostate cancer. MATERIALS AND METHODS/METHODS:A panel of clinicians from the AUA and SAR with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and technique MRI for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus. RESULTS:Prostate MRI should be performed according to technical specifications, technique standards, and interpreted according to standard reporting. Data support the use of MRI in men with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. Sufficient data now also exist to support the recommendation of MRI prior to biopsy for all men, without previous history of biopsy, under consideration for prostate biopsy. There is currently insufficient evidence to recommend MRI for screening, staging or surveillance of prostate cancer. CONCLUSIONS:Utility of prostate MRI in the risk stratification, diagnosis, and treatment pathway of men with prostate cancer is expanding. When a quality prostate MRI is obtained, current evidence now supports its use in men at risk of harboring prostate cancer prior to their first biopsy, as well as in men with a rising PSA following an initial negative standard prostate biopsy procedure.