Department of Urology, AMC University Hospital, Amsterdam, the Netherlands.
BJU Int. 2014 Feb;113(2):218-27. doi: 10.1111/bju.12243. Epub 2013 Nov 13.
To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy.
Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy?
Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation.
The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.
就多参数磁共振成像（mpMRI）在识别局灶性治疗患者中的应用达成共识。
来自欧洲和北美的泌尿科医生、放射科医生和基础研究人员参加了关于 mpMRI 在前列腺癌局灶性治疗中应用的共识会议。共识过程是面对面的，提出了具体的临床问题，并在可能的情况下寻求达成一致。所有参与者均列在作者名单中。该主题不包括前列腺癌的分期，而是确定进行 MRI 的最佳要求，以及目前优化执行 mpMRI 的现状，以(i)确定前列腺癌的局灶性（例如，定位≥0.5ml 的小靶病变），(ii)监测和评估局灶性消融治疗的结果，以及(iii)确定新 MRI 方法的诊断优势。此外，如果有高质量的 mpMRI，还讨论了在选择局灶性治疗患者时是否需要经会阴模板饱和活检。换句话说，mpMRI 是否可以替代经会阴饱和活检在局灶性治疗患者选择中的作用？
会议的大多数关键方面都达成了共识；然而，在 mpMRI 的最佳要求定义方面，存在不同意见。如果在高质量机器（3T 带/不带直肠内线圈或 1.5T 带直肠内线圈）上进行并由经验丰富的放射科医生进行评估，mpMRI 是实现局灶性治疗所需目标的最佳方法。前列腺 MRI 的结构化和标准化报告至关重要。最先进的 mpMRI 能够定位局灶性治疗的小肿瘤。最先进的 mpMRI 是局灶性消融后随访的首选技术。
目前 MRI 在局灶性治疗中的证据有限。mpMRI 还不够精确，无法始终准确分级肿瘤侵袭性。当有高质量的最先进的 mpMRI 时，模板引导的饱和活检不再必要；然而，可疑病变仍应通过（靶向）活检确认。
