Mueller-Lisse U G, Miller K
Institut für klinische Radiologie, LMU München, Klinikum der Universität München, Ziemssenstrasse 1, 80336 München.
Urologe A. 2010 Feb;49(2):190-8. doi: 10.1007/s00120-010-2235-6.
The new S3 guideline on prostate cancer includes imaging modalities applied for early detection, primary diagnosis, and staging of prostate cancer. Detection and primary diagnosis are based on digital rectal examination, serum PSA levels, and prostate biopsy. Among the imaging modalities, MRI shows the highest test quality parameters. Although MRI cannot replace biopsy to prove prostate cancer, its high negative predictive value can help to reduce the number of subsequent biopsies after negative prostate biopsy. For T-staging, MRI also demonstrates the highest test quality parameters. Its clinical application is limited, since therapeutic consequences are restricted. Due to its high specificity, MRI can save unnecessary pelvic lymph node dissections in patients at high risk for lymph node metastasis (N-staging). Risk-adjusted bone scans, complemented by additional radiological examinations if necessary, remain the standard to assess hematogenous metastasis (M staging).
新的前列腺癌S3指南涵盖了用于前列腺癌早期检测、初步诊断和分期的成像方式。检测和初步诊断基于直肠指检、血清前列腺特异抗原（PSA）水平以及前列腺活检。在成像方式中，磁共振成像（MRI）显示出最高的检测质量参数。虽然MRI不能替代活检来确诊前列腺癌，但其高阴性预测值有助于减少前列腺活检结果为阴性后的后续活检次数。对于T分期，MRI同样显示出最高的检测质量参数。其临床应用有限，因为治疗后果受限。由于其高特异性，MRI可避免对有淋巴结转移高风险患者（N分期）进行不必要的盆腔淋巴结清扫。风险调整后的骨扫描，必要时辅以其他放射学检查，仍然是评估血行转移（M分期）的标准方法。
