Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
J Natl Compr Canc Netw. 2019 May 1;17(5):506-513. doi: 10.6004/jnccn.2019.7306.
Prostate cancer (PCa) represents a significant source of morbidity and mortality for men in the United States, with approximately 1 in 9 being diagnosed with PCa in their lifetime. The role of imaging in the evaluation of men with PCa has evolved and currently plays a central role in diagnosis, treatment planning, and evaluation of recurrence. Appropriate use of multiparametric MRI (mpMRI) and MRI-guided transrectal ultrasound (MR-TRUS) biopsy increases the detection of clinically significant PCa while decreasing the detection of clinically insignificant PCa. This process may help patients with clinically insignificant PCa avoid the adverse effects of unnecessary therapy. In the setting of a known PCa, patients with low-grade disease can be observed using active surveillance, which often includes a combination of prostate-specific antigen (PSA) testing, serial mpMRI, and, if indicated, follow-up systematic and targeted TRUS-guided tissue sampling. mpMRI can provide important information in the posttreatment setting, but PET/CT is creating a paradigm shift in imaging standards for patients with locally recurrent and metastatic PCa. This article examines the strengths and limitations of mpMRI for initial PCa diagnosis, active surveillance, recurrent disease evaluation, and image-guided biopsies, and the use of PET/CT imaging in men with recurrent PCa. The goal of this review is to provide a rational basis for current NCCN Clinical Practice Guidelines in Oncology for PCa as they pertain to the use of these advanced imaging modalities.
前列腺癌（PCa）是美国男性发病率和死亡率较高的疾病之一，大约有 1/9 的男性会在一生中被诊断为 PCa。影像学在 PCa 男性的评估中发挥着重要作用，目前在诊断、治疗计划和复发评估中发挥着核心作用。适当应用多参数磁共振成像（mpMRI）和磁共振引导经直肠超声（MR-TRUS）活检可提高临床显著 PCa 的检出率，同时降低临床不显著 PCa 的检出率。这一过程有助于避免不必要治疗对临床不显著 PCa 患者的不良影响。在已知 PCa 的情况下，低级别疾病患者可采用主动监测，通常包括前列腺特异性抗原（PSA）检测、mpMRI 连续监测，如果有必要，还可进行后续的系统和靶向经直肠超声引导组织取样。mpMRI 在治疗后评估中可提供重要信息，但 PET/CT 正在改变局部复发性和转移性 PCa 患者的影像学标准。本文探讨了 mpMRI 在初始 PCa 诊断、主动监测、复发性疾病评估和图像引导活检中的优势和局限性，以及在复发性 PCa 患者中应用 PET/CT 成像的情况。本文的目的是为 NCCN 临床实践指南中的相关内容提供合理依据，这些指南涉及这些先进影像学方法的应用。
