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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2017 May 08

DOI: 10.23736/S0393-2249.17.02819-3


language: English

MRI in prostate cancer detection and management: a systematic review

Fabio MONNI 1, Paolo FONTANELLA 2, Angelica GRASSO 3, Peter WIKLUND 4, Yen-Chuan OU 5, Marco RANDAZZO 6, Bernardo ROCCO 7, Emanuele MONTANARI 3, Giampaolo BIANCHI 7

1 Department of Urology, Ospedale Regionale di Lugano, Lugano, Switzerland; 2 Department of Surgery, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland; 3 Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; 4 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; 5 Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; 6 Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland; 7 Department of Urology, University of Modena and Reggio Emilia, Modena, Italy


INTRODUCTION: The aim of our work was to evaluate the role of multi-parametric MRI (mpMRI) in detection and management of prostate cancer (PC); specifically investigating the efficacy of mpMRI-based biopsy techniques in terms of diagnostic yield of significant prostate neoplasm and the improved management of patient who choose conservative treatments or active surveillance.
EVIDENCE ACQUISITION: A systematic and critical analysis through Medline, Embase, Scopus and Web of Science databases was carried out in March 2016, following the PRISMA (“Preferred Reporting Items for Systematic Reviews and Meta-Analyses”) statement. The search was conducted using the following key words: MRI/TRUS-fusion biopsy; PIRADS; prostate cancer; magnetic resonance imaging (MRI); multiparametric MRI (mpMRI); systematic prostate biopsy (SB); targeted prostate biopsy (TPB). English language articles were reviewed for inclusion ability.
EVIDENCE SYNTHESIS: 66 studies were selected in order to evaluate the characteristics and limitations of traditional sample biopsy, the role of mpMRI in detection of prostate cancer, specifically the increased degree of diagnostic accuracy of targeted prostate biopsy compared to systematic biopsy (12 cores), and to transperineal saturation biopsies with trans-rectal ultrasound (TRUS) only. MpMRI can detect index lesions in approximately 90% of cases when compared to prostatectomy specimen. The diagnostic performance of biparametric MRI (T2w + DWI) is not inferior to mpMRI, offering valid options to diminish cost- and time-consumption. Since approximately 10% of significant lesions are still MRI-invisible, systematic cores biopsy seem to still be necessary. The analysis of the different techniques shows that in-bore MRI-guided biopsy and MRI/TRUS-fusion-guided biopsy are superior in detection of significant prostate cancer compared to visual estimation alone. MpMRI proved to be very effective in active surveillance, as it prevents underdetection of significant PC and it assesses low-risk disease accurately. In higher-risk disease, pre-surgical MRI may change the clinically-based surgical plan in up to a third of cases.
CONCLUSIONS: Targeted prostate biopsy, guided by mpMRI, is able to improve diagnostic accuracy and to reduce the detection of insignificant prostate cancer. Since the negative predictive value (NPV) of mpMRI is still imperfect, systematic cores biopsy should not be omitted for optimal staging of disease. A process of a progressive and periodic evolution in the detection and radiological classification of prostate lesions (such as PIRADS), is still needed in patients in active surveillance and in radical prostatectomy planning.

KEY WORDS: MRI - Prostate cancer - Cancer staging - Systematic biopsy

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Monni F, Fontanella P, Grasso A, Wiklund P, Ou YC, Randazzo M, et al. MRI in prostate cancer detection and management: a systematic review. Minerva Urol Nefrol 2017 May 08. DOI: 10.23736/S0393-2249.17.02819-3 

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