Schoots Ivo G, Moore Caroline M, Rouvière Olivier
aDepartment of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam bDepartment of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands cDivision of Surgical and Interventional Science, University College London dDepartment of Urology, University College London Hospitals Trust, London, United Kingdom eHospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot fUniversité de Lyon, faculté de médecine Lyon Est, Lyon, France.
Curr Opin Urol. 2017 May;27(3):238-245. doi: 10.1097/MOU.0000000000000397.
In men on active surveillance for localized prostate cancer, MRI and MRI-targeted biopsies can be used prior to confirmatory or surveillance biopsy, to detect individuals with high-grade cancer (the wolf in sheep's clothing). However, some men will have low-risk disease despite adverse MRI findings (the sheep in wolf's clothing). We review the value addition of MRI-targeted biopsies in comparison to systematic transrectal ultrasound-guided biopsies, using pathological reclassification as an end-point.
At confirmatory and surveillance biopsies, both the MRI-targeted and repeat standard biopsies have shown value in identifying histologically adverse findings in men with low-risk prostate cancer. For maximal detection of clinically significant cancer, a prebiopsy MRI should be performed together with both MRI-targeted and systematic transrectal ultrasound-guided biopsies. Stable disease on MRI may reduce the need for serial biopsies in some men on active surveillance.
Prostate MRI and subsequent MRI-targeted biopsies are worthwhile to the current management of men with low-risk prostate cancer on active surveillance. Prostate MRI, in combination with a multivariable risk-prediction model may help in identifying both the wolf in sheep's clothing and the sheep in wolf's clothing, and in potentially reducing the need for serial biopsies.
对于接受局限性前列腺癌主动监测的男性，在进行确诊性或监测性活检之前，可使用MRI和MRI靶向活检来检测患有高级别癌症的个体（即“披着羊皮的狼”）。然而，尽管MRI检查结果不利，但仍有一些男性患有低风险疾病（即“披着狼皮的羊”）。我们以病理重新分类为终点，回顾了与系统性经直肠超声引导活检相比，MRI靶向活检的附加价值。
在确诊性和监测性活检中，MRI靶向活检和重复标准活检在识别低风险前列腺癌男性的组织学不良发现方面均显示出价值。为了最大程度地检测出具有临床意义的癌症，活检前应同时进行MRI检查以及MRI靶向活检和系统性经直肠超声引导活检。MRI显示疾病稳定可能会减少一些接受主动监测的男性进行系列活检的需求。
前列腺MRI及随后的MRI靶向活检对于当前接受主动监测的低风险前列腺癌男性的管理是有价值的。前列腺MRI与多变量风险预测模型相结合，可能有助于识别“披着羊皮的狼”和“披着狼皮的羊”，并有可能减少系列活检的需求。
