Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project - Scorecard - MDSpire
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Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project
Clinical Scorecard: Application of Multiparametric Prostate MRI in Clinical Settings and Focal Treatment: Insights from a Delphi Consensus Initiative
At a Glance
Category
Detail
Condition
Clinically significant prostate cancer (PCa)
Key Mechanisms
Multiparametric MRI (mpMRI) combining T1-2-weighted imaging, dynamic contrast-enhanced (DCE), and diffusion-weighted imaging (DWI) for lesion characterization and risk assessment
Target Population
Patients with suspected or diagnosed prostate cancer undergoing diagnosis, surveillance, or focal therapy
Care Setting
Urological clinical practice and focal therapy centers with access to standardized mpMRI protocols and MRI-TRUS fusion biopsy systems
Key Highlights
mpMRI improves detection of clinically significant prostate cancer with high positive and negative predictive values, especially in expert centers with standardized protocols.
mpMRI-TRUS fusion targeted biopsies increase detection of clinically significant PCa and reduce detection of insignificant PCa compared to standard TRUS biopsies.
Repeated mpMRI is recommended during surveillance following focal therapy to monitor disease status.
Guideline-Based Recommendations
Diagnosis
Use standardized mpMRI acquisition and reporting protocols (e.g., PI-RADS v2 or Likert scale) for prostate imaging.
Employ mpMRI-TRUS fusion targeted biopsies to improve detection of clinically significant PCa, especially after previous negative TRUS biopsies.
Avoid use of 1.5 Tesla MRI scanners without an endorectal coil or pelvic phased-array coil; ERC is indispensable with older 1.5T systems.
Management
Utilize mpMRI findings for adequate patient selection and treatment planning in focal therapy of prostate cancer.
Incorporate mpMRI-TRUS fusion biopsy results to guide focal ablative modalities such as cryosurgery, high-intensity focused ultrasound, and others.
Monitoring & Follow-up
Perform repeated mpMRI during active surveillance and after focal therapy to detect residual or recurrent clinically significant prostate cancer.
Risks
Recognition that mpMRI performance varies outside expert centers; quality assurance through standardized acquisition, interpretation, and image-pathology feedback is critical.
Potential variability in predictive values depending on lesion size and imaging quality.
Patient & Prescribing Data
Patients undergoing prostate cancer diagnosis, active surveillance, or focal therapy
mpMRI combined with MRI-TRUS fusion targeted biopsies enhances detection accuracy and informs focal treatment decisions, improving management of clinically significant prostate cancer.
Clinical Best Practices
Ensure use of high-quality mpMRI protocols with appropriate coils and field strength (preferably ≥1.5T with endorectal coil for older systems).
Adopt standardized reporting systems such as PI-RADS v2 to facilitate consistent interpretation and communication.
Integrate mpMRI findings with targeted biopsy techniques to optimize detection and reduce unnecessary biopsies.
Maintain multidisciplinary collaboration among urologists, radiologists, pathologists, and oncologists for comprehensive patient care.
Implement repeated mpMRI assessments during surveillance and post-focal therapy follow-up.
by M. J. Scheltema, K. J. Tay, A. W. Postema, D. M. de Bruin, J. Feller, J. J. Futterer, A. K. George, R. T. Gupta, F. Kahmann, C. Kastner, M. P. Laguna, S. Natarajan, S. Rais-Bahrami, A. R. Rastinehad, T. M. de Reijke, G. Salomon, N. Stone, R. van Velthoven, R. Villani, A. Villers, J. Walz, T. J. Polascik, J. J. M. C. H. de la Rosette
