Texas Health Presbyterian Hospital of Dallas, Dallas, Texas.
Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
J Urol. 2017 Oct;198(4):832-838. doi: 10.1016/j.juro.2017.04.101. Epub 2017 May 5.
We summarize the available data about the clinical and economic effectiveness of magnetic resonance imaging in the diagnosis and management of prostate cancer, and provide practical recommendations for its use in the screening, diagnosis, staging and surveillance of prostate cancer.
A panel of clinicians with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and effectiveness of magnetic resonance imaging for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus.
At this time the data support the use of magnetic resonance imaging in patients with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. The data regarding its usefulness for initial biopsy suggest a possible role for magnetic resonance imaging in some circumstances. There is currently insufficient evidence to recommend magnetic resonance imaging for screening, staging or surveillance of prostate cancer.
Although it adds cost to the management of prostate cancer, magnetic resonance imaging offers superior anatomic detail, and the ability to evaluate cellular density based on water diffusion and blood flow based on contrast enhancement. Imaging targeted biopsy may increase the diagnosis of clinically significant cancers by identifying specific lesions not visible on conventional ultrasound. The clinical indications for the use of magnetic resonance imaging in the management of prostate cancer are rapidly evolving.
我们总结了磁共振成像在前列腺癌诊断和管理方面的临床和经济有效性的现有数据，并就其在前列腺癌筛查、诊断、分期和监测中的应用提供了实用建议。
一组在前列腺癌诊断和管理方面具有专业知识的临床医生评估了目前关于磁共振成像在该疾病中的应用和有效性的已发表文献。当有足够的研究可供分析时，根据数据提出建议；当没有足够的研究时，则根据专家共识提出建议。
目前的数据支持在以前活检阴性且持续存在前列腺癌风险增加的患者中使用磁共振成像。关于其在初始活检中有用性的数据表明，在某些情况下磁共振成像可能具有一定作用。目前尚无足够证据推荐磁共振成像用于前列腺癌的筛查、分期或监测。
尽管磁共振成像增加了前列腺癌管理的成本，但它提供了优越的解剖细节，以及基于水扩散评估细胞密度和基于对比增强评估血流的能力。靶向磁共振成像引导下的活检可能通过识别传统超声无法显示的特定病变来增加对临床显著癌症的诊断。磁共振成像在前列腺癌管理中的临床应用指征正在迅速发展。
