Diagnosis and Monitoring of Prostatic Lesions: A Comparison of Three Modalities: Multiparametric MRI, Fusion MRI/Transrectal Ultrasound (TRUS), and Traditional TRUS

PURPOSE  Transrectal ultrasound (TRUS) has been the gold standard of imaging for diagnosing prostate cancer for decades but is plagued by user error and undersampling. We aim to explore imaging modalities that are now being used in combination or alone for screening, diagnosis, and/or active surveillance of prostate cancer. METHODS A PubMed literature search was performed to include articles published up to April 2016. Data were extracted and analyzed. RESULTS Several large-scale studies have found an increased cancer detection rate in MRI-targeted lesions with an improved ability to target anterior lesions as well as an increased cancer detection in high-risk cancers using fusion platforms vs TRUS alone. CONCLUSIONS To date, there have been few head-to-head trials to directly compare the use of multiparametric MRI (mpMRI), transrectal ultrasound, and MRI-ultrasound fusion modalities for accurate and reliable detection, active surveillance, or biopsy procedure success rates. Further investigation utilizing these modalities are needed before they can be relied upon in active surveillance management, although mpMRI appears to be currently the most reliable in monitoring and diagnosing prostate lesions.