Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Prostate cancer is a major public health burden throughout the world. The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and the slow natural progression and biological heterogeneity of the disease, has made its management a complex and controversial issue. There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits. There are a number of clinical parameters and clinical nomograms to help with the choice of treatment. Magnetic resonance imaging (MRI) is a technique which makes safer, more individualized therapies possible due to high spatial resolution, superior contrast resolution, multiplanar capability, and a large field of view. Other MRI techniques such as MR spectroscopic imaging, dynamic contrast-enhanced MRI or perfusion MRI, and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry, Brownian motion of water molecules, and capillary wall permeability, respectively. This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, some future prospects for MRI in prostate cancer management are given.