Role of magnetic resonance imaging in defining a biopsy strategy for detection of prostate cancer

Prostate cancer is the second most common male cancer worldwide. It has a broad spectrum, from low-risk, clinically indolent disease, to high-risk aggressive cancer. This variety conveys certain diagnostic and management challenges. The use of prostate-specific antigen as a screening test for prostate cancer is increasing the diagnosis of low-grade, low-volume disease. By targeting biopsies towards suspicious areas on multiparametric magnetic resonance imaging, we can accurately diagnose clinically significant prostate cancer, reducing identification of low-risk, clinically indolent disease. This could avoid the radical treatment of histopathological cancer that might never have become clinically apparent. In the present review, we consider the use of multiparametric magnetic resonance imaging to inform the biopsy strategy. By identification of suspicious lesions on multiparametric magnetic resonance imaging, biopsy targets can be identified, and the sampling bias associated with blind standard transrectal prostate biopsy can be reduced. We consider the reliability of these radiological lesions for detection of clinically significant prostate cancer, and the methods of targeting them to ensure the radiological lesion is accurately sampled. Evidence suggests that targeted biopsy is efficient and accurate for diagnosis of clinically significant prostate cancer. By rationalizing diagnosis, and subsequently preventing overtreatment of clinically insignificant disease, magnetic resonance imaging-informed prostate biopsy can provide a method for streamlining the diagnostic pathway in prostate cancer.