Further features that increase confidence in diagnosing prostate cancer on TRUS are asymmetry in prostate size (particularly in the peripheral zone), capsular distortion and loss of differentiation between the central gland and peripheral zone. On TRUS, a relatively safe and inexpensive imaging modality, prostate cancer is most often hypoechoic relative to the normal peripheral zone but may sometimes be isoechoic or even hyperechoic. Transrectal ultrasound (TRUS) and positron emission tomography (PET) are other imaging modalities which can be used to assess the prostate and aid in diagnosis and localisation, therapy, staging, active surveillance and recurrence monitoring. mpMRI can also be utilised in active surveillance for patients with low- and intermediate-risk prostate cancer and guide targeted prostate biopsies. Multiparametric MRI (mpMRI) prostate allows accurate anatomical and functional imaging of the prostate gland and diagnosis of significant (intermediate and high risk) prostate cancer. Additionally, being able to diagnose more serious incidental pathologies early can be life-saving and potentially significantly alter patient management. Given that patients undertaking a prostate MRI are usually a cohort with increased anxiety from their known or suspicion of prostate cancer, it is important that radiologists are familiar with these common incidental findings to minimise anxiety to the patient, have a well-informed discussion with the referring clinician and reduce costs associated with unnecessary further testing and follow-up of benign incidental findings. Being familiar with standard MRI characteristics and a sound knowledge of anatomy of the prostate and surrounding structures can help in distinguishing normal anatomy from pathology. The field of view in a multiparametric prostate MRI includes other pelvic organs, neurovascular bundles, bowel, lymph nodes and bones. These incidental findings may be related to the genitourinary system or non- genitourinary system and may have a benign aetiology which needs no additional follow-up, or it may require surveillance and management. ![]() The increase in use has also led to increased diagnosis of incidental lesions arising from structures around the prostate. Prostate MRI has seen rapid growth in use in recent years as an advanced diagnostic modality to detect focal areas of clinically significant prostate cancer, to identify an area for targeted biopsy and to guide management and surveillance.
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