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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.

International audience; PURPOSE: Dutasteride, which is licensed for symptomatic benign prostatic hyperplasia, has been associated with a lower progression rate of low risk prostate cancer. We evaluated the effect of dutasteride on prostate cancer volume as assessed by T2-weighted magnetic resonance imaging.MATERIALS AND METHODS: In this randomized, double-blind, placebo controlled trial, men with biopsy proven, low-intermediate risk prostate cancer (up to Gleason 3 + 4 and PSA up to 15 ng/ml) who had visible lesion of 0.2 ml or greater on T2-weighted magnetic resonance imaging sequences were randomized to daily dutasteride 0.5 mg or placebo for 6 months. Lesion volume was assessed at baseline, and 3 and 6 months with image guided biopsy to the lesion at study exit. The primary end point was the percent reduction in lesion volume over 6 months. This trial was registered with the European Clinical Trials register (EudraCT 2009-102405-18).RESULTS: A total of 42 men were recruited between June 2010 and January 2012. In the dutasteride group, the average volumes at baseline and 6 months were 0.55 and 0.38 ml, respectively and the average reduction was 36%. In the placebo group, the average volumes at baseline and 6 months were 0.65 and 0.76 ml, respectively, and the average reduction was -12%. The difference in percent reductions between the groups was 48% (95% CI 27.4-68.3, p

The use of light for the treatment of disease has been well reported in historical literature and can be traced back to ancient times. ‘Heliotherapy’, or whole body sun exposure, was popular in ancient Greece, and other ancient cultures used similar strategies for the treatment of skin diseases such as psoriasis and vitiligo. Sunlight exposure has also been used for treating other conditions, including scurvy, paralysis, oedema and muscle weakness. The potential contribution of light therapy was recognised with a Nobel Prize in 1903, for the use of carbon arc phototherapy in the treatment of cutaneous tuberculosis. Currently, the therapeutic use of light takes various forms, including UVA light exposure for skin disease, phototherapy for jaundice in neonates and photodynamic therapy.

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.

PURPOSE OF REVIEW The aim of active surveillance is to avoid radical treatment and its side-effects in men who have truly low risk prostate cancer, whilst offering radical treatment to those men who are at higher risk of local progression or metastatic disease. The traditional tools used to attribute these risk categories are prostate specific antigen, digital rectal examination, transrectal biopsy and their repeated application over time. MRI is emerging as a tool which may be able to more accurately determine the risk of significant disease at diagnosis and progression of disease over time. This review will examine the role of MRI in men on active surveillance. RECENT FINDINGS The body of work on MRI as a tool for the detection of significant cancer is rapidly increasing, both in men undergoing initial assessment for prostate cancer risk, and in those who have low risk cancer on standard transrectal ultrasound guided biopsy. In addition, the use of MRI as a tool to detect change in prostate cancer is being explored by a small number of groups. SUMMARY Multiparametric MRI is a useful tool in the initial assessment and surveillance of men who choose to avoid radical treatment when first diagnosed with localized prostate cancer.