By Dr Peter Seidensticker, head of medical affairs radiology, Bayer
Prostate cancer continues to be a significant global health challenge, standing as the second most prevalent cancer among men worldwide.
As diagnosis and treatment evolve, it is crucial to develop strategies that effectively balance the need for early detection of aggressive, clinically relevant cancers with the risks of overdiagnosis and overtreatment of indolent tumours.
In this context, multiparametric (mp) Magnetic Resonance Imaging (MRI) is emerging as an imaging technique poised to drive a much-needed paradigm shift that prioritises the patient perspective and tailored treatment approaches.
Challenges in diagnosis
With more than 63,000 men diagnosed with prostate cancer every year in the UK, and that number expected to grow as the population ages, screening is essential, as early detection can lead to improved outcomes.
However, historically, prostate cancer has been a challenging area when it comes to detection and categorisation,1 often leading to unnecessary biopsies or overly aggressive treatment.
Serum prostate-specific antigen (PSA) screening in at-risk men is an established tool to help detect prostate cancer at an early stage, often before signs and symptoms occur.
Dr Peter Seidensticker
However, it is rather unspecific and can indicate inflammation or simply a large volume of the prostate as well.
When PSA results exceed a certain limit, a – quite invasive – biopsy is typically recommended.
Current analyses suggest that many biopsies may be unnecessary.
That’s where advancements in prostate cancer imaging come in – especially the use of mpMRI, which is emerging as an alternative for detecting and locally staging prostate cancer.
Value of MRI-informed decision-making
Prostate MRI is therefore becoming a standard in patient evaluations.
mpMRI has proven its value as a non-invasive imaging modality in accurately selecting patients who require immediate treatment and identifying those suitable for active surveillance.
Research continues to evaluate the emerging role of mpMRI in prostate imaging, yielding highly encouraging findings.
The prospective, observational, longitudinal, cohort PROKOMB trial performed at the Charité, Berlin, Germany and supported by Bayer, evaluated the role of mpMRI in detecting clinically significant prostate cancer in 593 men with suspected prostate cancer based on an elevated serum PSA level, a positive digital-rectal exam, or both, and had not undergone a prior biopsy.
Results showed that an MRI-informed strategy was able to prevent biopsies in 41 per cent of all men and in 86 per cent of MRI-negative men over three years without compromising oncologic safety.
These findings indicate that a prebiopsy MRI can support the detection of clinically significant cancers – and spare men with negative MRI results from unnecessary procedures that can be invasive, painful and potentially harmful without increasing their risk of missing a clinically significant prostate cancer.
Looking ahead: driving innovation in MRI imaging
With an expected rise in prostate cancer cases in the coming years,4 continuous innovation in diagnostic imaging is essential.
This encompasses not only technological improvements but also the research and development of contrast agents.
Over the past three decades, since their market introduction by Bayer more than 35 years ago, gadolinium-based contrast agents (GBCAs) have been widely utilised in MRI to support physicians in distinguishing cancerous tissue and facilitate diagnosis, staging and monitoring.
Bayer has remained committed to fostering innovation in this area.
In conclusion, with prostate cancer posing a significant global health challenge, effective screening and diagnostic strategies are more needed than ever.
The emergence of contrast-enhanced mpMRI marks a critical advancement in prostate cancer management, enabling accurate diagnosis and staging while bearing the potential of reducing unnecessary biopsies and overtreatment of less aggressive tumours.
Continued innovation in this area will be vital in optimising outcomes for patients as we address the complexities of prostate cancer diagnosis.
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