Diagnostic MRI is increasingly adopted in the care and management of patients with suspected or known localized prostate cancer. MRI is considered state-of-the-art for local tumor staging and visualization. A diagnostic acquisition protocol that includes high-resolution T2-weighted FSE and diffusion imaging (DWI) with or without dynamic imaging during IV contrast injection, can accurately identify sub-regions of gross tumor burden (Figure 1) and the presence of gross extracapsular extension or seminal vesicle invasion (stage T3). (Weinreb et al.) It stems that its integration in diagnostic and therapeutic interventions is well justified in the context of tumor-targeting.

The first and most established application consists of an MRI-informed (i.e. offline) and TRUS-guided strategy for needle guidance. (Churukanti et la.) Data regarding the benefit of this approach for improving diagnostic biopsy yield are mounting. However, issues of registration error remain. We and others have pursued MRI-only workflows to needle guidance in order to address this problem. (Ménard et al.) We will review the current state-of-the-art in actuated and robotic devices that have been developed in order to enable such a workflow.

Such platforms enable highly resolved imaging-pathology correlation activities, and the importance of such platforms in the realm of cancer research will be emphasized. Cancer is a highly heterogeneous disease, mandating exquisitve accuracy and precision for such activities. Interventional MRI is poised to address this challenge.

Finally, focal therapeutic modalities including brachytherapy, laser therapy, HIFU, and cryotherapy have been used under MRI-guidance in small single- institution series. The potential role of these approaches will be discussed in the context of designing an interventional trajectory with high potential for clinical relevance and impact.