Surveillance Value of Apparent Diffusion Coefficient Maps: Multiparametric MRI in Active Surveillance of Prostate Cancer

SIMPLE SUMMARY: Prostate cancer is one of the leading oncological diseases in the male population. Early detection and treatment of the disease gives better survival chances and a better long-term prognosis. The aim of this study is to establish the value of magnetic resonance imaging sequences for the detection and active surveillance of prostate cancer. The collected data from 530 patients indicate that the apparent diffusion coefficient (ADC) is the most specific and sensitive magnetic resonance sequence. Therefore, we advocate for its inclusion in the routine scanning protocol for prostate cancer. We advise on at least a bi-parametric magnetic resonance that includes apparent diffusion coefficient and a T2 sequence. ABSTRACT: Background: This study aims to establish the value of apparent diffusion coefficient maps and other magnetic resonance sequences for active surveillance of prostate cancer. The study included 530 men with an average age of 66, who were under surveillance for prostate cancer. We have used multiparametric magnetic resonance imaging with subsequent transperineal biopsy (TPB) to verify the imaging findings. Results: We have observed a level of agreement of 67.30% between the apparent diffusion coefficient (ADC) maps, other magnetic resonance sequences, and the biopsy results. The sensitivity of the apparent diffusion coefficient is 97.14%, and the specificity is 37.50%. According to our data, apparent diffusion coefficient is the most accurate sequence, followed by diffusion imaging in prostate cancer detection. Conclusions: Based on our findings we advocate that the apparent diffusion coefficient should be included as an essential part of magnetic resonance scanning protocols for prostate cancer in at least bi-parametric settings. The best option will be apparent diffusion coefficient combined with diffusion imaging and T2 sequences. Further large-scale prospective controlled studies are required to define the precise role of multiparametric and bi-parametric magnetic resonance in the active surveillance of prostate cancer.