The role of endorectal coil MRI in preoperative staging and decision-making for the treatment of clinically localized prostate cancer

The optimal management of newly diagnosed prostate cancer requires individualization of the treatment plan based upon the most accurate clinical characterization of tumor location and extent of disease. The role of imaging in prostate cancer staging continues to evolve. In this review, we address the utility of endorectal coil magnetic resonance imaging (eMRI) in both local staging and its ability to facilitate the decision in choosing one treatment strategy over another after the initial diagnosis of localized prostate cancer. Using the PubMed database and reference lists of key articles, we identified studies addressing the use of eMRI in tumor characterization and risk stratification in patients undergoing treatment for clinically localized prostate cancer. The findings identified within 54 selected studies were incorporated into a summary discussing the current limitations in cancer staging and the role eMRI plays in both the preoperative assessment and clinical decision-making in an attempt to improve our ability to individualize management approaches and tailor treatment. eMRI allows for more accurate local staging by complementing the existing clinical variables through improvements in spatial characterization of the prostatic zonal anatomy and molecular changes. These improvements in tumor staging enhance our ability to individualize treatment selection and tailor the approach to maximize cancer control while minimizing treatment related morbidity.