Magnetic resonance imaging sequences for prostate cancer triage: two is a couple, three is a crowd?

Prostate cancer (PCa) can exhibit a wide spectrum of clinical behavior, ranging from extremely indolent to highly lethal. For clinicians, the main challenge is to avoid over-diagnosis and consequently over-treatment of incidental tumors while at the same time not underestimating any clinically significant prostate cancers (SPCa). The standard diagnostic pathway in men who present with an elevated serum prostate specific antigen (PSA) consisted of transrectal ultrasound (TRUS)-guided biopsies with systematic “template” sampling of the entire prostate gland without prior knowledge of the likely locations of the tumor(s). As a result, many men without cancer underwent unnecessary biopsies, clinically insignificant cancers were too often detected, and clinically significant cancers sometimes missed.