Differences Between MRI-Visible Vs. MRI-Invisible Cancers: Biology and Outcomes

Multiparametric magnetic resonance imaging (MRI) has dramatically shifted the management of localized prostate cancer and enhances our ability to accurately diagnosis and risk stratify patients at risk for prostate cancer. However, a significant proportion of clinically significant prostate cancers are not detected on MRI, and the biological basis of MRI-invisible disease remains unclear. Here, we review the literature evaluating the utility of prostate MRI as a diagnostic tool for lesion characterization and targeting. Additionally, we explore the genomic and pathophysiologic characteristics underlying MRI visibility as well as the prognostic outcomes associated with MRI-visible and MRI-invisible prostate cancer.