Prostate cancer (PCa) has become the leading malignancy in men and the second most common cause of cancer related death in most Western countries. In India, compared to the West, the incidence of PCa is lower. In recent years, however, a steady increase is seen and thus detection at an early stage is key for appropriate treatment. The existing screening methods of diagnosis of PCa like prostate specific antigen (PSA) level, digital rectal examination (DRE), etc., lack specificity, resulting in a high negative biopsy rate. Thus, there is an increasing interest in the use of non-invasive methods like magnetic resonance for improving the yield of transrectal ultrasound guided biopsies of the prostate in men suspected to have PCa based on elevated PSA or abnormal DRE. This involves the use of MR methods in pre-biopsy population rather than for staging the disease after a biopsy confirmation.
In our Institute, the identification of suspicious areas of malignancy of the prostate was carried out using MRI, diffusion MRI (DWI) and MRSI. Further, we evaluated their role in a large cohort of Indian men prior to biopsy, which marks a shift from the earlier strategy of conducting post-biopsy MR investigations. Our data indicated that pre-biopsy MRSI and DWI are useful in identifying patients who, upon prostate biopsy, are more likely to show a malignancy of the prostate gland. Moreover, our data showed that pre-biopsy MR investigations have a potential role in increasing the specificity of screening for early PCa. It also has a role in the targeting of biopsy sites, avoiding unnecessary biopsies and predicting the outcome of biopsies. These results showed that pre-biopsy MR investigations addresses certain goals that were not accomplished by a post-biopsy MR study and may help to answer some of the questions in PCa management