Editorial for “Luminal Water Imaging: Comparison With Diffusion‐Weighted Imaging (DWI) and PI‐RADS for Characterization of Prostate Cancer Aggressiveness”
Abstract
Most prostate cancers (PCa) are still treated with surgical resection or radiation therapy despite excellent prognosis. Better understanding of the significance of histopathologic growth patterns in PCa (ie, Gleason score, International Society of Urological Pathology [ISUP] grade groups [GG]) has resulted in several proposed classifications that attempt to distinguish indolent PCa from clinically significant PCa (csPCa). Increasing evidence indicates that low Gleason/ISUP grade group 1 tumors have excellent prognosis when left untreated. The Prostate Imaging Reporting and Data System (PI-RADS) v. 2 is the established clinical guideline for radiologists to interpret and report suspicious findings on prostate multiparametric magnetic resonance imaging (mpMRI). Data support the adoption of targeted biopsies of abnormalities seen on mpMRI (ie, PI-RADS score 3–5) as the preferred and superior approach to diagnose men at clinical risk of csPCa. Despite the unequivocal value of PI-RADS to help standardize image interpretation and guide patient management, its ability to differentiate indolent tumors from csPCa is only modest. This differentiation is likely influenced by the subjective nature and sensitivity to interobserver variability of PI-RADS. Efforts toward validating more objective mpMRI-based biomarkers of PCa aggressiveness have been reported. An inverse correlation between apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) and…
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