Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy .
Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
Acta Biomed. 2020 Sep 23;91(10-S):e2020012. doi: 10.23750/abm.v91i10-S.10251.
Clinical suspicion of Prostate Cancer (PCa) is largely based on increased prostate specific antigen (PSA) level and/or abnormal digital rectal examination (DRE) and/or positive imaging and, up today, biopsy is mandatory to confirm the diagnosis. The old model consisted of Standard Biopsy (SBx), that is random sampling of the prostate gland under ultrasound guidance (TRUS), in subjects with clinical suspicion of PCa. This involves the risk of not diagnosing a high percentage of tumors (up to 30%) and of an incorrect risk stratification. Multiparametric Magnetic Resonance Imaging (mpMRI) has transformed the diagnostic pathway of PCa, not only as an imaging method for detecting suspicious lesions, but also as an intraprocedural guidance for Target Biopsy (MRI-TBx), thus bridging the diagnostic gap. Several single and multicenter randomized trials, such as PROMIS, MRI first, PRECISION and that reported by Van der Leest et al. have confirmed the superiority of the "MRI pathway", consisting of mpMRI and MRI-TBx of suspicious lesions, over the "standard pathway" of SBx in all patients with elevated PSA and/or positive DRE. MRI-TBx appears to be advantageous in reducing the overall number of biopsies performed, as well as in reducing the diagnosis of clinically insignificant disease while maintaining or improving the diagnosis of clinically significant PCa (cs-PCa). Moreover, it shows a reduction in the diagnosis of ins-PCa, and therefore, of overdiagnosis, when using MRI-TBx without sacrificing performance in the diagnosis of cs-PCa.
临床怀疑前列腺癌（PCa）主要基于前列腺特异性抗原（PSA）水平升高和/或异常数字直肠检查（DRE）和/或阳性影像学，迄今为止，活检是确诊的必要手段。旧模型包括标准活检（SBx），即在超声引导下（TRUS）对前列腺进行随机取样，适用于有 PCa 临床怀疑的患者。这涉及到未诊断出高比例肿瘤（高达 30%）和错误风险分层的风险。多参数磁共振成像（mpMRI）改变了 PCa 的诊断途径，不仅作为一种检测可疑病变的影像学方法，而且作为靶向活检（MRI-TBx）的术中指导，从而弥合了诊断差距。几项单中心和多中心随机试验，如 PROMIS、MRI 优先、PRECISION 以及 Van der Leest 等人报告的试验，证实了“MRI 途径”（包括 mpMRI 和可疑病变的 MRI-TBx）优于 SBx 的“标准途径”在所有 PSA 升高和/或 DRE 阳性的患者中的优越性。MRI-TBx 似乎在减少活检总数、减少临床意义不大的疾病诊断方面具有优势，同时保持或改善临床意义重大的 PCa（cs-PCa）的诊断。此外，当不牺牲 cs-PCa 诊断性能的情况下使用 MRI-TBx 时，它显示出降低了 ins-PCa 的诊断率，从而降低了过度诊断率。
