title: Performance of multiparametric magnetic resonance imaging in the evaluation and management of clinically low-risk prostate cancer.
abstract: OBJECTIVE
  The purpose of this article is to review the multiparametric magnetic resonance imaging (mMRI) of the prostate and MR-guided prostate biopsy, and their role in the evaluation and management of men with low-risk prostate cancer.
  
  
  METHODS
  We performed a literature review based on the MEDLINE database search for publications on the role of mMRI (a) in detection and localization of prostate cancer, prediction of tumor aggressiveness and progression and (b) in guiding targeted prostate biopsy.
  
  
  RESULTS
  The mMRI, particularly diffusion-weighted imaging with T2-weighted imaging, is a useful tool for tumor localization in low-risk prostate cancer as it can detect lesions that are more likely missed on extended biopsy schemes and can identify clinically significant disease requiring definitive treatment. The MR-guided biopsy of the most suspicious lesions enables more accurate and safer approach to guide enrollment into the active surveillance program. However, the MR-guided biopsy is complex. The fusion of MRI data with transrectal ultrasound for the purpose of biopsy provides a more feasible technique with documented accurate sampling.
  
  
  CONCLUSIONS
  Although the mMRI is not routinely used for risk stratification and prognostic assessment in prostate cancer, it can provide valuable information to guide management of men with low-risk disease. Incorporation of mMRI into the workup and monitoring of patients with low-risk prostate cancer can help discriminate clinically significant disease from indolent disease. Targeted biopsy of MR-suspicious lesions enables accurate sampling of potentially aggressive tumors that may affect outcomes.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD.
authors.forename: Seyed Saeid
authors.initials: SS
authors.lastname: Dianat
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins University, Baltimore, MD.
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD; The James Buchanan Brady Urological Institute, The Johns Hopkins University, Baltimore, MD. Electronic address: kmacura@jhmi.edu.
authors.forename: Katarzyna J
authors.initials: KJ
authors.lastname: Macura
mesh_terms: D001706:Biopsy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D011859:Radiography; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*
keywords: Active surveillance; Biopsy; Multiparametric MRI; Prostate cancer