The Imaging in prostate cancer: An integrated radiology–urology review with emphasis on resource-limited settings in Pakistan

Abstract

Background:

Prostate cancer is among the most common cancers diagnosed in men all over the world and a new health issue affecting Pakistan. Advancement in imaging has radically changed the route to diagnosis, precision of staging and post-therapeutic monitoring, making radiology the focus of clinical decision making.

Objective:

To evaluate the modern imaging modalities in prostate cancer and suggest a hierarchical, risk-based imaging system that could be implemented within the resource-constrained healthcare environment.

Methods:

The critical review of key international guidelines and high-impact clinical trials in the area of transrectal ultrasound (TRUS), multiparametric magnetic resonance imaging (mpMRI), computed tomography (CT), bone scintigraphy, whole-body MRI, and prostate-specific membrane antigen (PSMA) PET/CT was performed. The focus was laid on diagnostic performance, clinical impact, and implementation issues pertaining to Pakistan.

Results:

mpMRI has transformed the pre-biopsy diagnosis to enhance clinically significant prostate cancer and local staging based on standardized PI-RADS reporting. MRI-targeted biopsy plans show improvements in diagnostic output and a decreased detection of low grade disease. To assess PSMA metastases, PSMA PET/CT has shown higher diagnostic accuracy than traditional imaging and has been shown to have a significant impact on therapeutic planning. Molecular imaging is used to offer early localization of disease in cases of biochemical recurrence to lead to individualized salvage. Risk-stratified imaging algorithm is a clinical benefit-maximizing algorithm in a resource-limited environment that considers infrastructure constraints.