Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Division of Surgery & Interventional Science, University College London, London, UK.
Prostate Cancer Prostatic Dis. 2018 Nov;21(4):473-487. doi: 10.1038/s41391-018-0071-8. Epub 2018 Aug 13.
In recent years, evidence has accrued to support the introduction of multiparametric magnetic resonance imaging (mpMRI) in the prostate cancer diagnostic pathway. The exact role of mpMRI in different settings is not widely agreed. In this review, we look at the use of MRI in three groups of men: biopsy naive men, those with a previous negative biopsy and those with a previous positive biopsy suitable for active surveillance.
An electronic MEDLINE/PubMed search up to 24th January 2018 was performed, using the search terms (prostate cancer OR prostate adenocarcinoma) AND (MRI OR magnetic resonance) AND (biopsy naive OR active surveillance OR prior negative biopsy OR no prior biopsy). Only those studies which reported detection rates of standard biopsy and MRI-targeted biopsy, where all men had both an MRI and standard biopsy were included.
In total 34 articles were included (14 biopsy naive, 10 prior negative biopsy, and 10 prior positive biopsy). MRI-targeted biopsy consistently resulted in greater detection of clinically significant prostate cancer, and a lower detection of clinically insignificant prostate cancer, across all three patient populations. This effect was most prominent in men with at least one previous negative biopsy, and least prominent in men on active surveillance. In the presence of a negative mpMRI detection of csPCa found at systematic biopsy ranged from 0 to 20%.
MRI-targeted biopsy is more efficient than standard biopsy in detecting clinically significant disease in men with a positive MRI, and results in less detection of clinically insignificant cancer. In men with a negative MRI, a significant minority of men will have clinically significant cancer detected on systematic biopsy.
近年来，有证据支持在前列腺癌诊断途径中引入多参数磁共振成像（mpMRI）。mpMRI 在不同环境中的确切作用尚未得到广泛认可。在本综述中，我们研究了 MRI 在三组男性中的应用：初次活检的男性、先前阴性活检的男性和先前阳性活检适合主动监测的男性。
我们进行了截至 2018 年 1 月 24 日的电子 MEDLINE/PubMed 搜索，使用的检索词为（前列腺癌或前列腺腺癌）和（MRI 或磁共振）和（初次活检或主动监测或先前阴性活检或无先前活检）。仅纳入了报告标准活检和 MRI 靶向活检检出率的研究，所有男性均接受 MRI 和标准活检。
共纳入 34 篇文章（14 篇初次活检、10 篇先前阴性活检和 10 篇先前阳性活检）。MRI 靶向活检在所有三组患者中均一致地提高了临床显著前列腺癌的检出率，降低了临床不显著前列腺癌的检出率。这种效果在至少有一次先前阴性活检的男性中最为明显，在主动监测的男性中最为不明显。在 mpMRI 阴性的情况下，系统活检发现的 csPCa 检出率从 0 到 20%不等。
在 MRI 阳性的男性中，MRI 靶向活检比标准活检更有效地检测临床显著疾病，并导致较少的临床不显著癌症检出。在 MRI 阴性的男性中，少数男性会在系统活检中发现临床显著的癌症。
