Editing Cancer Care Ontario: MRI in Prostate Cancer Diagnosis (2017)



'''See Original Guideline'''

'''See MRI in Prostate Cancer Chapter Notes'''

===== Background =====

* mpMRI examination combines imaging features from at least three of the following data sets: T2-weighted imaging
* (T2WI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced T1-weighted imaging (DCE-MRI), and proton spectroscopy (MRSI).

===== Recommendations =====

* '''In patients with an elevated risk of clinically significant prostate cancer (according to PSA levels and/or nomograms) who are biopsy-naïve, mpMRI followed by targeted biopsy (biopsy directed at cancer-suspicious foci detected with mpMRI) should not be considered the standard of care.'''
** Specificity and positive predictive value of mpMRI were not high.
* '''In patients who had a prior negative TRUS-guided systematic biopsy and demonstrate an increasing risk of having clinically significant prostate cancer since prior biopsy (e.g., continued rise in PSA and/or change in findings from digital rectal examination), mpMRI followed by targeted biopsy may be considered to help in detecting more clinically significant prostate cancer patients compared with repeated TRUS-guided systematic biopsy'''