Hoeks Caroline M A, Fütterer Jurgen J, Somford Diederik M, van Oort Inge M, Huisman Henkjan, Barentsz Jelle O
Universitair Medisch Centrum St. Radboud, Afd. Radiologie, Nijmegen, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:B487.
Two recent studies on prostate cancer screening gave conflicting results about the effects of screening on prostate cancer mortality. The current screening method of PSA determination in combination with transrectal ultrasonic biopsy leads to a large number of false positive results and overtreatment. A screening test is needed that reduces the number of unnecessary prostate biopsies and which discriminates between more and less aggressive forms of prostate cancer. Multiparametric MRI has a high specificity for prostate cancer detection and provides information about prostate cancer aggressiveness. PSA in combination with multiparametric MRI performed at 1.5 Tesla appears to be a fairly accurate screening test. Due to its high costs and limited availability, multiparametric MRI is not suitable as a primary screening test. However, it could serve as a subsequent screening test if the PSA has increased above threshold values. Using multiparametric MRI as a follow-up test during screening would provide more accurate biopsies, prevent unnecessary prostate biopsies and improve the characterization of prostate cancer.
最近两项关于前列腺癌筛查的研究,在筛查对前列腺癌死亡率的影响方面给出了相互矛盾的结果。目前前列腺特异性抗原(PSA)测定结合经直肠超声活检的筛查方法导致大量假阳性结果和过度治疗。需要一种筛查测试,既能减少不必要的前列腺活检数量,又能区分侵袭性较强和较弱的前列腺癌形式。多参数磁共振成像(MRI)对前列腺癌检测具有高特异性,并能提供有关前列腺癌侵袭性的信息。PSA与1.5特斯拉的多参数MRI相结合似乎是一种相当准确的筛查测试。由于成本高且可用性有限,多参数MRI不适合作为主要筛查测试。然而,如果PSA升高超过阈值,它可以作为后续筛查测试。在筛查期间使用多参数MRI作为后续测试将提供更准确的活检,防止不必要的前列腺活检,并改善前列腺癌的特征描述。