Role of MRI prebiopsy in men at risk for prostate cancer: taking off the blindfold.

PURPOSE OF REVIEW We review recent literature surrounding the use of prebiopsy prostate MRI and MRI-targeted biopsy in men at risk for prostate cancer. RECENT FINDINGS Large series have strengthened the case for the use of MRI prior to prostate biopsy to maximize the detection of clinically significant disease, reduce the detection of clinically insignificant disease, and allow for tumor localization during targeted biopsy. Prebiopsy MRI followed by targeted biopsy appears to have the ability to overcome the limitations of the standard 12-core template. Use of MRI and targeted biopsy in the setting of a prior negative biopsy is supported by the literature and a recent consensus statement by the American Urological Association and the Society of Abdominal Radiology Prostate Cancer Disease-Focused Panel but is contingent upon the availability and quality of multiparametric MRI acquisition and interpretation. In men with no previous biopsy, MRI and targeted biopsy appears to increase detection of clinically significant disease compared with systematic biopsy while reducing detection of indolent disease. The addition of prostate cancer biomarkers and predictive nomograms may further enhance prebiopsy risk assessment. SUMMARY Prostate MRI prior to biopsy may guide counseling regarding prostate cancer risk, allow for accurate tumor localization during targeted biopsy, and increase detection of clinically significant cancer while limiting detection of indolent disease. Its use prior to biopsy, in conjunction with biomarkers and predictive nomograms, may allow deferral of biopsy in select cases.