[Clinical aspects in the diagnosis and treatment of prostate cancer].

Background: Diagnosis and treatment of primary prostate cancer (PCA) have undergone significant changes in the last few years due to modern imaging.

Objectives: Established and modern diagnostic and therapeutic modalities for detection and treatment of primary PCA are presented and discussed critically.

Materials and methods: Background knowledge and guideline recommendations on primary PCA are summarized and additional information from relevant publications is given.

Results: Modern imaging, in particular multiparametric magnetic resonance imaging (mpMRI), has revolutionized the diagnostic work-up of primary PCA. Due to mpMRI, tumors are detected significantly better in both initial and re-biopsy with a significant reduction of overdiagnosis of clinically insignificant PCA. Therapeutic approaches such as active surveillance, radical prostatectomy and focal therapies are increasingly being planned and carried out relying on MR-imaging information concerning tumor extent and tumor aggressiveness. In addition, prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) has shown superiority in assessing patients with suspected biochemical recurrence and in primary staging of PCA compared to conventional imaging in terms of detection of metastases.

Conclusions: Modern imaging, especially mpMRI and PSMA-PET/CT, has added substantial benefits in modern diagnosis and treatment of primary PCA. Moreover, multiparametric ultrasound is also a promising addition to the radiological armamentarium in the management of primary PCA.