de Marini Pierre, Cazzato Roberto Luigi, Garnon Julien, Shaygi Behnam, Koch Guillaume, Auloge Pierre, Tricard Thibault, Lang Hervé, Gangi Afshin
Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France.
Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
BJR Open. 2019 Jun 3;1(1):20180043. doi: 10.1259/bjro.20180043. eCollection 2019.
Prostate cancer (PCa) is the most common malignant tumor in males. The benefits in terms of overall reduction in specific mortality due to the widespread use of Prostate Specific Antigen (PSA) screening and the advancements in the curative treatments (radical prostatectomy or radiotherapy) appear to have reached a plateau. There remains, however, the questions of overdiagnosis and overtreatment of such patients. Currently, the main challenge in the treatment of patients with clinically organ-confined PCa is to offer an oncologically efficient treatment with as little morbidity as possible. Amongst the arising novel curative techniques for PCa, cryoablation (CA) is the most established one, which is also included in the NICE and AUA guidelines. CA is commonly performed under ultrasound guidance with the inherent limitations associated with this technique. The recent advancements in MRI have significantly improved the accuracy of detecting and characterizing a clinically significant PCa. This, alongside the development of wide bore interventional MR scanners, has opened the pathway for in bore PCa treatment. Under MRI guidance, PCa CA can be used either as a standard whole gland treatment or as a tumor targeted one. With MR-fluoroscopy, needle guidance capability, multiplanar and real-time visualization of the iceball, MRI eliminates the inherent limitations of ultrasound guidance and can potentially lead to a lower rate of local complications. The aim of this review article is to provide an overview about PCa CA with a more specific insight on MR guided PCa CA; the limitations, challenges and applications of this novel technique will be discussed.
前列腺癌（PCa）是男性最常见的恶性肿瘤。由于广泛使用前列腺特异性抗原（PSA）筛查以及根治性治疗（根治性前列腺切除术或放疗）的进展，在总体降低特定死亡率方面的益处似乎已达到平台期。然而，这类患者的过度诊断和过度治疗问题仍然存在。目前，临床器官局限性PCa患者治疗的主要挑战是提供一种肿瘤学上有效的治疗方法，同时尽可能减少发病率。在新兴的PCa根治技术中，冷冻消融（CA）是最成熟的一种，也被纳入了英国国家卫生与临床优化研究所（NICE）和美国泌尿外科学会（AUA）的指南。CA通常在超声引导下进行，存在与该技术相关的固有局限性。磁共振成像（MRI）的最新进展显著提高了检测和表征具有临床意义的PCa的准确性。这与大孔径介入式MR扫描仪的发展一起，为腔内PCa治疗开辟了道路。在MRI引导下，PCa CA既可以作为标准的全腺治疗，也可以作为肿瘤靶向治疗。通过MR透视、针引导能力、冰球的多平面和实时可视化，MRI消除了超声引导的固有局限性，并可能降低局部并发症的发生率。这篇综述文章的目的是提供关于PCa CA的概述，并对MR引导的PCa CA有更具体的见解；将讨论这种新技术的局限性、挑战和应用。
