The benefits and drawbacks of the dynamic contrast-enhanced MRI sequence for prostate cancer diagnosis are increasingly being recognized, with many centers adopting the biparametric (bp) MRI approach as the default initial approach. The abandonment of the routine use of contrast medium requires an assessment of the loss of diagnostic power against the gains in operational logistics, costs, time, capacity, and side effects. It is the balance of these factors weighted against the clinical priorities of patients that determines which patient groups can safely avoid dynamic contrast enhancement. Although systematic reviews and individual studies are broadly supportive of the bpMRI approach, the pathway impacts for men with suspected cancer using the bpMRI approach are still not well documented for clinical practice. Robust prospectively acquired data for bpMRI regarding biopsy avoidance, detection of clinically significant and insignificant cancers, and for increasing the precision of tumor grade and volume are needed. There is a requirement for prospective, randomized, or blinded head-to-head, multicenter studies, addressing the noninferiority of biopsy yields prompted by bpMRI and multiparametric MRI approaches. These studies should more precisely define patient groups where the benefits and harms of contrast enhancement are aligned to their clinical priorities. Only then can we be confident in recommending bpMRI as an initial diagnostic approach for prostate cancer diagnosis. Level of Evidence 1. Technical Efficacy Stage 5.
|Number of pages||10|
|Journal||Journal of Magnetic Resonance Imaging|
|Early online date||3 May 2020|
|Publication status||Published - Dec 2020|
Bibliographical noteFunding Information:
Mustafa R. Bashir, MD, discloses grants from CymaBay, Madrigal Pharmaceuticals, Metacrine, NGM and Pinnacle, institutional support from Clinical Research, ProSciento, and Siemens as principal investigator, and consultant fees from MedPace. CME Editor:
© 2020 International Society for Magnetic Resonance in Medicine