Schiavina Riccardo, Chessa Francesco, Borghesi Marco, Gaudiano Caterina, Bianchi Lorenzo, Corcioni Beniamino, Castellucci Paolo, Ceci Francesco, Ceravolo Isabella, Barchetti Giovanni, Del Monte Maurizio, Campa Riccardo, Catalano Carlo, Panebianco Valeria, Nanni Cristina, Fanti Stefano, Minervini Andrea, Porreca Angelo, Brunocilla Eugenio
Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy.
Radiology Unit, Department of Diagnostic Medicine and Prevention, St. Orsola-Malpighi Hospital, Bologna, Italy.
Int J Urol. 2019 Jan;26(1):18-30. doi: 10.1111/iju.13797. Epub 2018 Sep 20.
We aimed to review the current state-of-the-art imaging methods used for primary and secondary staging of prostate cancer, mainly focusing on multiparametric magnetic resonance imaging and positron-emission tomography/computed tomography with new radiotracers. An expert panel of urologists, radiologists and nuclear medicine physicians with wide experience in prostate cancer led a PubMed/MEDLINE search for prospective, retrospective original research, systematic review, meta-analyses and clinical guidelines for local and systemic staging of the primary tumor and recurrence disease after treatment. Despite magnetic resonance imaging having low sensitivity for microscopic extracapsular extension, it is now a mainstay of prostate cancer diagnosis and local staging, and is becoming a crucial tool in treatment planning. Cross-sectional imaging for nodal staging, such as computed tomography and magnetic resonance imaging, is clinically useless even in high-risk patients, but is still suggested by current clinical guidelines. Positron-emission tomography/computed tomography with newer tracers has some advantage over conventional images, but is not cost-effective. Bone scan and computed tomography are often useless in early biochemical relapse, when salvage treatments are potentially curative. New imaging modalities, such as prostate-specific membrane antigen positron-emission tomography/computed tomography and whole-body magnetic resonance imaging, are showing promising results for early local and systemic detection. Newer imaging techniques, such as multiparametric magnetic resonance imaging, whole-body magnetic resonance imaging and positron-emission tomography/computed tomography with prostate-specific membrane antigen, have the potential to fill the historical limitations of conventional imaging methods in some clinical situations of primary and secondary staging of prostate cancer.
我们旨在回顾目前用于前列腺癌原发和继发分期的先进成像方法，主要聚焦于多参数磁共振成像以及采用新型放射性示踪剂的正电子发射断层扫描/计算机断层扫描。一个由在前列腺癌方面经验丰富的泌尿科医生、放射科医生和核医学医生组成的专家小组，在PubMed/MEDLINE上检索了关于原发性肿瘤以及治疗后复发疾病的局部和全身分期的前瞻性、回顾性原始研究、系统评价、荟萃分析和临床指南。尽管磁共振成像对微观的包膜外扩展敏感性较低，但它现在是前列腺癌诊断和局部分期的主要手段，并且正成为治疗规划中的关键工具。用于淋巴结分期的横断面成像，如计算机断层扫描和磁共振成像，即使在高危患者中临床应用价值也不大，但目前的临床指南仍建议使用。采用更新型示踪剂的正电子发射断层扫描/计算机断层扫描比传统图像有一些优势，但不具有成本效益。在早期生化复发时，骨扫描和计算机断层扫描通常没有用处，而此时挽救性治疗可能具有治愈效果。新的成像模式，如前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描和全身磁共振成像，在早期局部和全身检测方面显示出有前景的结果。更新的成像技术，如多参数磁共振成像、全身磁共振成像以及采用前列腺特异性膜抗原的正电子发射断层扫描/计算机断层扫描，在前列腺癌原发和继发分期的某些临床情况下，有可能填补传统成像方法的历史局限性。
