Imaging of organ-confined prostate cancer: functional ultrasound, MRI and PET/computed tomography

To review the current status of advanced imaging techniques in identification of organ-confined prostate cancer with a focus on their impact on patient management.

Transrectal ultrasound suffers from poor accuracy despite significant technical improvements. Generally used to distinguish cancers with extraprostatic spread, MRI is now focusing on intraprostatic prostate cancer identification. At 1.5T, the most recent high-resolution pelvic phased-array coils provide excellent imaging of the whole gland, including this challenging anterior part. Improvements in accuracy for cancer detection and volume estimation result from dynamic contrast-enhanced and diffusion-weighted imaging sequences. Histological correlations showed high sensitivity/specificity for significant volume cancers. 3T MRI scanners will improve these results. Most of the recent PET/computed tomography imaging studies use choline derivatives ((11)C-choline and (18)F-fluorocholine). Their results are promising but insufficient to be currently recommended in routine practice.

Considerable advances have been made in the identification of organ-confined prostate cancer with multiparametric MRI. Only prebiopsy MRI can provide best quality of cancer assessment and allows for targeting biopsies. It is hoped that advances in 3T MRI as well as in radiotracers for PET/computed tomography will further improve diagnosis, treatment selection, planning and outcomes.