MR-based techniques for imaging prostate cancer metabolism: current status and future perspectives.

Prostate cancer (PCa) is a heterogeneous disease ranging from indolent to highly aggressive forms (e.g., castration-resistant PCa). Although multiparametric MRI plays an important role in the routine diagnosis and management of PCa, emerging challenges underscore a critical unmet need in the era of precision and personalized medicine. Given that metabolic reprogramming is a hallmark of PCa, metabolic imaging techniques that focus on and target changes in metabolic pathways, such as PET and hyperpolarized (HP) 13C MRI, represent critical tools for facilitating early diagnosis, risk stratification, and monitoring of PCa treatment. This review discusses the metabolic characteristics of PCa, the current landscape of MR-based metabolic imaging techniques, and their applications to PCa, with a particular emphasis on recent advances in proton magnetic resonance spectroscopy imaging (1H-MRSI), HP 13C MRI, and other emerging advanced MRI techniques, including chemical exchange saturation transfer (CEST) MRI, sodium (23Na) MRI, and deuterium metabolic imaging (DMI). Additionally, we discuss the challenges and future perspectives for their further clinical translation.