• Recapitulate the various therapeutic modalities used in the management of prostate cancer.

• Understand the radioanatomy of the prostate on MRI.

• Understand the MRI technique and protocol for post-therapeutic evaluation of the prostate.

• Understand the radiological features following treatment of prostate cancer.

Prostate cancer is a significant health concern, being the most common cancer in males and a leading cause of cancer-related deaths globally.

Multiparametric MRI plays a crucial role in the diagnosis, staging, and post-treatment evaluation of prostate cancer, offering detailed anatomical and functional information for precise management decisions.

Various therapeutic options are available for prostate cancer, including surgery, radiotherapy, hormone therapy, and targeted therapy, each with distinct effects on post-treatment imaging appearances.

Post-treatment MRI findings, such as signal alterations in the prostatic bed and nodular abnormalities, aid in detecting tumor recurrence and assessing treatment response .

Prostate cancer is the most common type of cancer in the male population and is the third leading cause of cancer-related deaths worldwide. Its diagnosis relies on clinical examination correlated with biological and imaging data, guiding the performance of biopsies to obtain histological confirmation. Thus, radiological exploration holds an increasingly significant role in the management of this cancer, whether for staging or surveillance purposes. Several therapeutic modalities can be employed, including surgery (radical or partial prostatectomy), radiotherapy, hormonotherapy, or targeted therapy.

Multiparametric MRI is the imaging modality of choice for exploring the prostate gland, allowing a detailed analysis of its different zones. It is based on morphological sequences to locate lesions, as well as functional sequences, such as diffusion-weighted imaging with apparent diffusion coefficient mapping and dynamic contrast-enhanced imaging. Although the PI-RADS score cannot be directly applied in these situations, analyzing lesions based on its item can be useful. Correlating the results of these sequences helps to avoid underestimating a lesion and overlooking a recurrence, or overestimating lesions as potential tumor recurrences.

Following surgical treatment, modifications in the prostatic bed are commonly observed, with signal alterations in different anatomical structures. Thus, after radical prostatectomy, the prostatic bed appears as a peri-urethral fibrous cuff. The search for tumor recurrence is the primary focus, notably at the vesicourethral anastomosis, seminal vesicle beds, retrovesical area, or bladder neck. Recurrence often presents as nodular signal abnormalities, restricted diffusion, and enhancement after contrast administration. In the context of radiotherapy treatment, T2 hypointensity of the prostate and seminal vesicles is commonly observed in most patients, along with loss of zonal anatomy and prostate volume reduction. However, the presence of a distinct nodular hypointensity does not necessarily indicate recurrence and may correspond to a treated lesion. Regarding hormonotherapy, the prostate typically decreases in volume with overall hypointensity.