Giganti Francesco, Stavrinides Vasilis, Moore Caroline M
Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
Division of Surgery & Interventional Science, University College London, London, UK.
Eur Urol Open Sci. 2022 Feb 26;38:40-43. doi: 10.1016/j.euros.2021.08.016. eCollection 2022 Apr.
Traditional protocols for active surveillance (AS) are commonly based on digital rectal examination, prostate-specific antigen (PSA), and standard transrectal biopsy, meaning that initial classification errors and inaccurate lesion monitoring can occur. Protocol-based biopsies are performed to assess changes in cancer grade and extent at prespecified intervals, but this approach represents a barrier to AS adherence and tolerability. There is evidence to support the use of magnetic resonance imaging (MRI) during AS, as this technique (associated with favourable PSA kinetics) offers an opportunity to follow patients on AS without the need for routine, protocol-based biopsies in the absence of signs of radiological progression provided that image quality, interpretation, and reporting of serial imaging are of the highest standards.
In this report we looked at the role of magnetic resonance imaging (MRI) scans in avoiding unnecessary prostate biopsies for patients being monitored for low- or intermediate-risk prostate cancer. We conclude that patients on active surveillance can be monitored with MRI scans over time and that biopsies could be used only when there are changes on MRI or a rising prostate-specific antigen (PSA) not explained by an increase in prostate size.
传统的主动监测（AS）方案通常基于直肠指检、前列腺特异性抗原（PSA）和标准经直肠活检，这意味着可能会出现初始分类错误和病变监测不准确的情况。基于方案的活检是为了在预定间隔评估癌症分级和范围的变化，但这种方法对AS的依从性和耐受性构成了障碍。有证据支持在AS期间使用磁共振成像（MRI），因为这种技术（与良好的PSA动力学相关）提供了一个机会，在没有放射学进展迹象的情况下，无需进行常规的、基于方案的活检，就可以对接受AS的患者进行随访，前提是连续成像的图像质量、解读和报告达到最高标准。
在本报告中，我们探讨了磁共振成像（MRI）扫描在避免对低风险或中风险前列腺癌患者进行不必要的前列腺活检方面的作用。我们得出结论，接受主动监测的患者可以通过MRI扫描进行长期监测，只有在MRI出现变化或前列腺特异性抗原（PSA）升高且无法用前列腺大小增加来解释时才进行活检。
