Prostate cancer ranks as the second most common cancer and the sixth leading cause of cancer-related deaths among men globally, with approximately 899,000 new cases and 258,000 deaths reported in 2008. Notably, 72% of these cases and 53% of deaths occurred in developed countries, which comprise less than 20% of the global population [1]. Advancing age remains the most significant risk factor, though men younger than 65 account for 25% of cases [2]. Familial history, particularly with first-degree relatives diagnosed with prostate cancer, doubles the risk [3]. Other proposed risk factors include dietary habits, alcohol consumption, UV radiation exposure, chronic inflammation, and occupational hazards [4].
Prostate-specific antigen (PSA) testing is extensively used for early detection, diagnosis, staging, and follow-up of prostate cancer. However, PSA levels can be elevated due to benign conditions, leading to unnecessary biopsies, especially in patients with PSA levels between 4 and 10 ng/mL [5]. The standard diagnostic tool, ultrasound-guided biopsy, is invasive and subject to sampling errors [6].
Magnetic resonance imaging (MRI) has long been employed to assess prostate anatomy and pathology. T2-weighted (T2W) MR imaging provides critical information for treatment planning by detecting, localizing, and staging prostate cancer, including evaluating extracapsular extension and seminal vesicle invasion [7]. While T2W imaging is highly sensitive, its specificity is lower, particularly in differentiating between cancerous and benign tissues [8]. Functional MR techniques, such as 3D H1 MR Spectroscopy (H1MRS), have been introduced to improve the diagnostic capabilities of traditional MRI, providing more accurate detection of malignancies [9]. Studies have shown that combining T2W imaging with H1MRS increases sensitivity to 71% and specificity to 90%, with histopathology as the gold standard [10].
Given the limitations of biopsies, including associated complications and diagnostic uncertainties, there is a clear need for improved non-invasive methods to select candidates for biopsy. The rationale of this study is to evaluate whether combining MRI and MRS can enhance clinical outcomes by reducing unnecessary biopsies and better predicting the presence of malignancies. By doing so, the study also aims to address issues such as post-biopsy hemorrhages, which often compromise the quality of MRI images.
This study aims to assess the diagnostic accuracy of combining T2-weighted MR imaging and H1 MR Spectroscopy for prostate cancer detection, using histopathology as the gold standard.