PURPOSE OF REVIEW: Prostate-specific antigen screening has led to a downstaging of prostate cancer that has resulted in overdiagnosis and overtreatment of the disease. The review discusses the potential role of imaging in identifying low-risk prostate cancer and enabling more appropriate management of the disease. RECENT FINDINGS: Clinical nomograms have been designed and validated for prediction of the probability of insignificant prostate cancer. The models integrate clinical and biopsy findings. Recently, nomogram models have been designed that incorporate MRI and magnetic resonance spectroscopic imaging data with clinical and biopsy data for prediction of insignificant prostate cancer; these models performed better than the clinical models. SUMMARY: Clinical nomograms for the prediction of insignificant disease provide more information than any diagnostic test alone; furthermore, nomograms that incorporate MRI or MRI/magnetic resonance spectroscopic imaging findings with clinical and biopsy data have been shown to improve the prediction of insignificant cancer. A greater level of certainty, however, is still needed to help segregate low-risk patients from intermediate and high-risk patients. Therefore, more research is needed on imaging of low-risk prostate cancer so that data-driven, evidence-based practice guidelines in oncology combining anatomical, metabolic and laboratory data can be designed.
