Endorectal MRI, now a fast and reliable examination, is an essential part of the local work-up for prostate cancer, regardless of the treatment envisioned. MRI spectroscopy, an actively maturing technique, makes it possible to combine anatomical and metabolic information that can be used for detection, staging, and posttreatment follow-up of prostate cancer. In patients with repeated negative biopsies, spectroscopy and dynamic gadolinium injection will be able to detect atypical cancer sites that escape routine biopsies. MRI of lymph nodes with ultrasmall superparamagnetic iron oxide (USPIO) injection will improve diagnostic performance in the detection of lymph node metastases. In the planning of conservative treatment, MRI and especially spectroscopic MRI will increasingly replace computed tomography. Finally, endorectal MRI of the prostate, spectroscopy, and dynamic injection will show local recurrences.
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