Glaser Zachary A, Porter Kristin K, Thomas John V, Gordetsky Jennifer B, Rais-Bahrami Soroush
Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Transl Androl Urol. 2018 Sep;7(Suppl 4):S411-S419. doi: 10.21037/tau.2018.03.21.
Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.
对于患有低风险局限性疾病的男性，前列腺癌（PCa）的主动监测（AS）通常被认为是一种安全的策略。然而，使用传统纳入标准时，多达四分之一的患者可能会被错误分类为适合主动监测。多参数磁共振成像（mpMRI）的使用可能会在初始诊断和疾病监测中提供更好的风险分层。我们对最近发表的研究进行了综述，以评估这种成像方式在这种临床情况下的效用。在PubMed上进行了英文文献检索，以查找有关局限性PCa、AS和磁共振成像的原始研究。我们的布尔检索标准包括以下术语：PCa、AS、成像、MRI、mpMRI、前瞻性、回顾性和比较性。我们的检索排除了评论、社论、指南、综述或访谈等出版物类型。我们的文献综述确定了71项原始研究。其中，52项符合我们的纳入标准。有证据表明，mpMRI改善了对临床显著性前列腺癌（csPCa）病灶的特征描述，并且这种方式提供的增强检测和风险分层可能会使男性避免被不恰当地安排进行主动监测。使用系列mpMRI还可能允许在确诊活检之间延长间隔时间。多项研究证明了MRI靶向活检的益处。对于考虑进行主动监测的临床低风险PCa男性，使用前列腺mpMRI可提高风险分层的可信度。在进行主动监测时，系列mpMRI和MRI靶向活检有助于检测侵袭性疾病转变或先前活检未发现的临床显著性癌症病灶。
