Cargando…
The primacy of multiparametric MRI in men with suspected prostate cancer
BACKGROUND: Multiparametric MRI (mpMRI) became recognised in investigating those with suspected prostate cancer between 2010 and 2012; in the USA, the preventative task force moratorium on PSA screening was a strong catalyst. In a few short years, it has been adopted into daily urological and oncolo...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828624/ https://www.ncbi.nlm.nih.gov/pubmed/31172275 http://dx.doi.org/10.1007/s00330-019-06166-z |
_version_ | 1783465388833505280 |
---|---|
author | Richenberg, Jonathan Løgager, Vibeke Panebianco, Valeria Rouviere, Olivier Villeirs, Geert Schoots, Ivo G. |
author_facet | Richenberg, Jonathan Løgager, Vibeke Panebianco, Valeria Rouviere, Olivier Villeirs, Geert Schoots, Ivo G. |
author_sort | Richenberg, Jonathan |
collection | PubMed |
description | BACKGROUND: Multiparametric MRI (mpMRI) became recognised in investigating those with suspected prostate cancer between 2010 and 2012; in the USA, the preventative task force moratorium on PSA screening was a strong catalyst. In a few short years, it has been adopted into daily urological and oncological practice. The pace of clinical uptake, born along by countless papers proclaiming high accuracy in detecting clinically significant prostate cancer, has sparked much debate about the timing of mpMRI within the traditional biopsy-driven clinical pathways. There are strongly held opposing views on using mpMRI as a triage test regarding the need for biopsy and/or guiding the biopsy pattern. OBJECTIVE: To review the evidence base and present a position paper on the role of mpMRI in the diagnosis and management of prostate cancer. METHODS: A subgroup of experts from the ESUR Prostate MRI Working Group conducted literature review and face to face and electronic exchanges to draw up a position statement. RESULTS: This paper considers diagnostic strategies for clinically significant prostate cancer; current national and international guidance; the impact of pre-biopsy mpMRI in detection of clinically significant and clinically insignificant neoplasms; the impact of pre-biopsy mpMRI on biopsy strategies and targeting; the notion of mpMRI within a wider risk evaluation on a patient by patient basis; the problems that beset mpMRI including inter-observer variability. CONCLUSIONS: The paper concludes with a set of suggestions for using mpMRI to influence who to biopsy and who not to biopsy at diagnosis. KEY POINTS: • Adopt mpMRI as the first, and primary, investigation in the workup of men with suspected prostate cancer. • PI-RADS assessment categories 1 and 2 have a high negative predictive value in excluding significant disease, and systematic biopsy may be postponed, especially in men with low-risk of disease following additional risk stratification. • PI-RADS assessment category lesions 4 and 5 should be targeted; PI-RADS assessment category lesion 3 may be biopsied as a target, as part of systematic biopsies or may be observed depending on risk stratification. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-019-06166-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6828624 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-68286242019-11-18 The primacy of multiparametric MRI in men with suspected prostate cancer Richenberg, Jonathan Løgager, Vibeke Panebianco, Valeria Rouviere, Olivier Villeirs, Geert Schoots, Ivo G. Eur Radiol Urogenital BACKGROUND: Multiparametric MRI (mpMRI) became recognised in investigating those with suspected prostate cancer between 2010 and 2012; in the USA, the preventative task force moratorium on PSA screening was a strong catalyst. In a few short years, it has been adopted into daily urological and oncological practice. The pace of clinical uptake, born along by countless papers proclaiming high accuracy in detecting clinically significant prostate cancer, has sparked much debate about the timing of mpMRI within the traditional biopsy-driven clinical pathways. There are strongly held opposing views on using mpMRI as a triage test regarding the need for biopsy and/or guiding the biopsy pattern. OBJECTIVE: To review the evidence base and present a position paper on the role of mpMRI in the diagnosis and management of prostate cancer. METHODS: A subgroup of experts from the ESUR Prostate MRI Working Group conducted literature review and face to face and electronic exchanges to draw up a position statement. RESULTS: This paper considers diagnostic strategies for clinically significant prostate cancer; current national and international guidance; the impact of pre-biopsy mpMRI in detection of clinically significant and clinically insignificant neoplasms; the impact of pre-biopsy mpMRI on biopsy strategies and targeting; the notion of mpMRI within a wider risk evaluation on a patient by patient basis; the problems that beset mpMRI including inter-observer variability. CONCLUSIONS: The paper concludes with a set of suggestions for using mpMRI to influence who to biopsy and who not to biopsy at diagnosis. KEY POINTS: • Adopt mpMRI as the first, and primary, investigation in the workup of men with suspected prostate cancer. • PI-RADS assessment categories 1 and 2 have a high negative predictive value in excluding significant disease, and systematic biopsy may be postponed, especially in men with low-risk of disease following additional risk stratification. • PI-RADS assessment category lesions 4 and 5 should be targeted; PI-RADS assessment category lesion 3 may be biopsied as a target, as part of systematic biopsies or may be observed depending on risk stratification. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-019-06166-z) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-06-06 2019 /pmc/articles/PMC6828624/ /pubmed/31172275 http://dx.doi.org/10.1007/s00330-019-06166-z Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Urogenital Richenberg, Jonathan Løgager, Vibeke Panebianco, Valeria Rouviere, Olivier Villeirs, Geert Schoots, Ivo G. The primacy of multiparametric MRI in men with suspected prostate cancer |
title | The primacy of multiparametric MRI in men with suspected prostate cancer |
title_full | The primacy of multiparametric MRI in men with suspected prostate cancer |
title_fullStr | The primacy of multiparametric MRI in men with suspected prostate cancer |
title_full_unstemmed | The primacy of multiparametric MRI in men with suspected prostate cancer |
title_short | The primacy of multiparametric MRI in men with suspected prostate cancer |
title_sort | primacy of multiparametric mri in men with suspected prostate cancer |
topic | Urogenital |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828624/ https://www.ncbi.nlm.nih.gov/pubmed/31172275 http://dx.doi.org/10.1007/s00330-019-06166-z |
work_keys_str_mv | AT richenbergjonathan theprimacyofmultiparametricmriinmenwithsuspectedprostatecancer AT løgagervibeke theprimacyofmultiparametricmriinmenwithsuspectedprostatecancer AT panebiancovaleria theprimacyofmultiparametricmriinmenwithsuspectedprostatecancer AT rouviereolivier theprimacyofmultiparametricmriinmenwithsuspectedprostatecancer AT villeirsgeert theprimacyofmultiparametricmriinmenwithsuspectedprostatecancer AT schootsivog theprimacyofmultiparametricmriinmenwithsuspectedprostatecancer AT richenbergjonathan primacyofmultiparametricmriinmenwithsuspectedprostatecancer AT løgagervibeke primacyofmultiparametricmriinmenwithsuspectedprostatecancer AT panebiancovaleria primacyofmultiparametricmriinmenwithsuspectedprostatecancer AT rouviereolivier primacyofmultiparametricmriinmenwithsuspectedprostatecancer AT villeirsgeert primacyofmultiparametricmriinmenwithsuspectedprostatecancer AT schootsivog primacyofmultiparametricmriinmenwithsuspectedprostatecancer |