Multi-parametric magnetic resonance imaging of prostate cancer

Traditionally, men suspected to have prostate cancer were diagnosed by histopathology of systematic transrectal ultrasound guided biopsies. No pre-biopsy imaging was performed. In the mid-nineties, the Radboudumc was one of few clinical institutes in the world that started studying these men with magnetic resonance imaging (MRI) (AJR Am J Roentgenol 1996). Initially, magnetic resonance spectroscopy was used to obtain functional information of prostate tissue (Magn Reson Med 1997 and Anticancer Res 1997), complemented by contrast-enhanced MRI (Radiology 1997). Over the next 20 years, the team published more than 50 scientific publications on this subject. Around 2010 diffusion-weighted MRI made its entrance and soon replaced spectroscopy as the main functional parameter in a multi-parametric (mp)MRI examination. Since then, using the close connection between the Departments of Urology, Radiology, and Pathology, research leaders from the Urological cancers theme of the Radboudumc have published many of the pivotal studies validating the different functional techniques in their abilities to differentiate cancer from non-cancer tissue (Eur Urol 2011; Invest Radiol 2012; Eur Urol 2013; Eur Urol 2014). The cost-effectiveness of the mpMRI procedure has been assessed (Eur Urol 2014) and the theme was invited to write well-cited reviews on the topic (Radiology 2011; AJR Am J Roentgenol 2014). Now, the Radboudumc has established the prostate MR center of excellence, training radiologists all over the world in interpreting mpMRI of the prostate, and standardizing mpMRI acquisition and interpretation methods with introducing the PIRADS system (Eur Radiol 2012; Eur Urol 2016; Eur Urol 2016). Currently, mpMRI has made its way into international guidelines for prostate cancer diagnosis. It has become the triage method for the diagnosis of men suspicious of having prostate cancer in the United Kingdom and Australia, with other European countries following. In summary, the theme Urological cancers has taken mpMRI of the prostate from pre-clinical research to (inter)national guidelines.