Department of Urology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
BJU Int. 2019 Nov;124(5):730-737. doi: 10.1111/bju.14705. Epub 2019 Mar 13.
To review the role of multiparametric magnetic resonance imaging (mpMRI) for active surveillance (AS) of prostate cancer.
We performed a comprehensive search of Medline and Embase databases for relevant articles in the English language. Search terms included 'prostate cancer', 'active surveillance' or 'monitoring', 'expectant management', and 'MRI'. We also reviewed practice guidelines from recognized international associations or societies involved in prostate cancer care. Articles were selected by both authors for relevance to the subject matter.
The ability of mpMRI to visualize primarily high-grade tumours within the prostate may improve risk stratification for men considering AS for prostate cancer. Multiple mostly single-institution studies have found that the addition of mpMRI and a targeted biopsy strategy can improve AS patient selection over standard TRUS biopsy alone. The high negative predictive value of mpMRI may allow men to avoid early repeat biopsy and may offer the possibility to tailor biopsy strategies. The presence of a radiographically positive lesion on mpMRI at baseline is predictive of higher likelihood of radiographic progression over time while on AS.
MRI has shown promise in both patient selection and monitoring for men who undergo AS for prostate cancer. There are multiple barriers to the widespread use of mpMRI for AS including quality, cost and access to care.
综述多参数磁共振成像（mpMRI）在前列腺癌主动监测（AS）中的作用。
我们在 Medline 和 Embase 数据库中用英文检索相关文献，检索词包括“前列腺癌”“主动监测”或“监测”“期待治疗”和“MRI”。我们还复习了参与前列腺癌诊治的国际知名协会或学会的实践指南。两位作者均根据与主题的相关性来选择文章。
mpMRI 能够显示前列腺内主要的高级别肿瘤，这可能有助于对考虑接受前列腺癌 AS 的男性进行风险分层。多项主要为单中心的研究发现，mpMRI 联合靶向活检策略可改善 AS 患者的选择，优于单纯标准经直肠超声（TRUS）活检。mpMRI 的高阴性预测值可使男性避免早期重复活检，并可能提供定制活检策略的可能性。基线时 mpMRI 上存在影像学阳性病变预示着在 AS 期间随着时间推移发生影像学进展的可能性更高。
MRI 在接受前列腺癌 AS 的男性的患者选择和监测方面均显示出良好的效果。mpMRI 广泛应用于 AS 存在多个障碍，包括质量、成本和获得医疗服务的机会。
