Department of Urology, Mayo Clinic, Rochester, MN, USA.
Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Nat Rev Clin Oncol. 2020 Jun;17(6):372-381. doi: 10.1038/s41571-020-0332-z. Epub 2020 Feb 28.
Following detection of high levels of serum prostate-specific antigen, many men are advised to have transrectal ultrasound-guided biopsy in an attempt to locate a cancer. This nontargeted approach lacks accuracy and carries a small risk of potentially life-threatening sepsis. Worse still, it can detect clinically insignificant cancer cells, which are unlikely to be the origin of advanced-stage disease. The detection of these indolent cancer cells has led to overdiagnosis, one of the major problems of contemporary medicine, whereby many men with clinically insignificant disease are advised to undergo unnecessary radical surgery or radiotherapy. Advances in imaging and biomarker discovery have led to a revolution in prostate cancer diagnosis, and nontargeted prostate biopsies should become obsolete. In this Perspective article, we describe the current diagnostic pathway for prostate cancer, which relies on nontargeted biopsies, and the problems linked to this pathway. We then discuss the utility of prebiopsy multiparametric MRI and novel tumour markers. Finally, we comment on how the incorporation of these advances into a new diagnostic pathway will affect the current risk-stratification system and explore future challenges.
在检测到高水平的血清前列腺特异性抗原后，许多男性被建议进行经直肠超声引导下的活检，以试图定位癌症。这种非靶向方法缺乏准确性，并存在潜在危及生命的败血症的小风险。更糟糕的是，它可以检测到临床意义不大的癌细胞，而这些癌细胞不太可能是晚期疾病的起源。这些惰性癌细胞的检测导致了过度诊断，这是当代医学的主要问题之一，许多患有临床意义不大的疾病的男性被建议接受不必要的根治性手术或放疗。成像和生物标志物发现方面的进步推动了前列腺癌诊断的革命，非靶向性前列腺活检应该过时了。在这篇观点文章中，我们描述了当前依赖于非靶向性活检的前列腺癌诊断途径，以及该途径相关的问题。然后，我们讨论了活检前多参数 MRI 和新型肿瘤标志物的应用。最后，我们评论了将这些进展纳入新的诊断途径将如何影响当前的风险分层系统，并探讨未来的挑战。
