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MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?

This review focuses on indeterminate lesions on prostate magnetic resonance imaging (MRI), assigned as PI-RADS category 3. The prevalence of PI-RADS 3 index lesion in the diagnostic work-up is significant, varying between one in three (32%) to one in five (22%) men, depending on patient cohort of fi...

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Autor principal: Schoots, Ivo G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861283/
https://www.ncbi.nlm.nih.gov/pubmed/29594022
http://dx.doi.org/10.21037/tau.2017.12.31
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author Schoots, Ivo G.
author_facet Schoots, Ivo G.
author_sort Schoots, Ivo G.
collection PubMed
description This review focuses on indeterminate lesions on prostate magnetic resonance imaging (MRI), assigned as PI-RADS category 3. The prevalence of PI-RADS 3 index lesion in the diagnostic work-up is significant, varying between one in three (32%) to one in five (22%) men, depending on patient cohort of first biopsies, previously negative biopsies, and active surveillance biopsies. A management strategy must be developed for this group of men with an indeterminate suspicion of having clinically significant prostate cancer (csPCa). Currently available data show that the actual prevalence of csPCa after targeted biopsy in PI-RADS 3 lesions vary between patients groups from one in five (21%) to one in six (16%), depending on previous biopsy status. Although this prevalence is lower in comparison to PI-RADS 4 and PI-RADS 5 lesions, still a considerable proportion of men harbor significant disease. Men with such a PI-RADS 3 lesion should therefore be adequately managed. In general, the clinical approach of using a threshold of PI-RADS ≥4 instead of PI-RADS ≥3 to select MRI for targeted biopsies is not supported by data from our explorative literature search using current definitions of csPCa. A possible adaptation to the threshold of PI-RADS ≥4 in combination with other clinical markers could be considered within an active surveillance protocol, where the balance between the individual risk of missing csPCa and the constant process of repeating prostate biopsies is crucial. In the future, improvements in MR imaging and interpretation, combined with molecular biomarkers and multivariate risk models will all be employed in prostate cancer detection and monitoring. These combinations will aid decision-making in challenging circumstances, such as unclear and diagnostic equivocal results for csPCa at early detection.
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spelling pubmed-58612832018-03-28 MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions? Schoots, Ivo G. Transl Androl Urol Review Article This review focuses on indeterminate lesions on prostate magnetic resonance imaging (MRI), assigned as PI-RADS category 3. The prevalence of PI-RADS 3 index lesion in the diagnostic work-up is significant, varying between one in three (32%) to one in five (22%) men, depending on patient cohort of first biopsies, previously negative biopsies, and active surveillance biopsies. A management strategy must be developed for this group of men with an indeterminate suspicion of having clinically significant prostate cancer (csPCa). Currently available data show that the actual prevalence of csPCa after targeted biopsy in PI-RADS 3 lesions vary between patients groups from one in five (21%) to one in six (16%), depending on previous biopsy status. Although this prevalence is lower in comparison to PI-RADS 4 and PI-RADS 5 lesions, still a considerable proportion of men harbor significant disease. Men with such a PI-RADS 3 lesion should therefore be adequately managed. In general, the clinical approach of using a threshold of PI-RADS ≥4 instead of PI-RADS ≥3 to select MRI for targeted biopsies is not supported by data from our explorative literature search using current definitions of csPCa. A possible adaptation to the threshold of PI-RADS ≥4 in combination with other clinical markers could be considered within an active surveillance protocol, where the balance between the individual risk of missing csPCa and the constant process of repeating prostate biopsies is crucial. In the future, improvements in MR imaging and interpretation, combined with molecular biomarkers and multivariate risk models will all be employed in prostate cancer detection and monitoring. These combinations will aid decision-making in challenging circumstances, such as unclear and diagnostic equivocal results for csPCa at early detection. AME Publishing Company 2018-02 /pmc/articles/PMC5861283/ /pubmed/29594022 http://dx.doi.org/10.21037/tau.2017.12.31 Text en 2018 Translational Andrology and Urology. All rights reserved.
spellingShingle Review Article
Schoots, Ivo G.
MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
title MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
title_full MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
title_fullStr MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
title_full_unstemmed MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
title_short MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
title_sort mri in early prostate cancer detection: how to manage indeterminate or equivocal pi-rads 3 lesions?
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861283/
https://www.ncbi.nlm.nih.gov/pubmed/29594022
http://dx.doi.org/10.21037/tau.2017.12.31
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