Evolution of precise and multimodal MRI and TRUS in detection and management of early prostate cancer

The combination of T2-weighted MRI with functional MRI, including contrast-enhanced MRI, diffusion-weighted imaging and magnetic resonance spectroscopy, has been recognized as the most promising diagnostic modality for the detection and staging of localized prostate cancer. In spite of the relatively low predictive value of the transrectal ultrasonography (US) image alone, transrectal US-guided prostate biopsy is currently the most clinically used, gold standard technique to confirm pathological prostate cancer. A possible way of improving the precision of prostate biopsy is to use computer-aided analysis, the fusion of the US image with MRI, or by introducing contrast-enhanced US, elastography and/or 3D US to be coupled with computer-assistance or robotic needle placement. Computer-aided surgical navigation systems with image-fusion or image-overlaying capability, integrated with real-time organ tracking systems and/or robotic systems for feedback on the 3D spatial positions of the surgical targets and instruments, can provide attractive opportunities to improve the digitally-coordinated precision of minimally invasive urology, along with predictive ability to guide toward ideal surgical outcomes.