Magnetic resonance elastography for prostate cancer: advancing diagnostic accuracy, tumor characterization, and clinical applications.

Prostate cancer (PCa) is the second most frequently diagnosed malignancy in men worldwide and a leading cause of cancer-related mortality. The clinical course of PCa is constantly improving, with a trend toward ever greater precision diagnostics and less invasive methods. Magnetic resonance elastography (MRE), a novel modality for quantifying tissue stiffness, significantly enhances detection as a complement to conventional multiparametric magnetic resonance imaging (mpMRI). Providing information about the mechanical properties of prostate tissue, MRE enhances the detection, localization, and characterization of malignant tumors, particularly those that are not optimally visualized with conventional methods. This review covers the underlying principles of MRE, its technological developments, such as tomoelastography, and its application in differentiating PCa from benign prostatic hyperplasia and normal parenchyma. Clinical studies have indicated that increased stiffness of the prostate gland may be associated with cancer aggressiveness, and MRE can be used to improve diagnostic performance when it is combined with mpMRI. Emerging technologies, such as radiomics, artificial intelligence-driven segmentation, and high-frequency driver systems, have created new possibilities for applying MRE in the diagnosis and follow-up of PCa and treatment. In conclusion, MRE can be a great complement to mpMRI, and could potentially improve diagnosis, risk stratification, and treatment monitoring of PCa in future clinical practice.