Role of multi-parametric (mp) MRI in prostate cancer

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer and for the assessment of extra-capsular extension, distal urethral sphincter and seminal vesicles involvement. The role of multi-parametric magnetic resonance imaging in follow-up of patients on active surveillance is also increasingly recognised. Its role is now further expanded to facilitate targeted therapies. This review focuses on the evolving role of multi-parametric magnetic resonance imaging in diagnosis and management of prostate cancer.