MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
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DOI：
10.21037/tau.2017.12.31
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发表时间：
2018-03
影响因子：
2
通讯作者：
Schoots IG
中科院分区：
文献类型：
--
作者：
Schoots IG
本文综述了前列腺磁共振成像（MRI）上的不确定病变，归类为PI-RADS 3类。在诊断检查中，PI-RADS 3指数病变的患病率是显著的，从三分之一（32%）到五分之一（22%）不等，这取决于首次活检、既往阴性活检和主动监测活检的患者队列。必须为这组有临床显著性前列腺癌（csPCa）的不确定怀疑的男性制定管理策略。目前可获得的数据显示，PI-RADS 3病变靶向活检后csPCa的实际患病率在患者组之间的差异从五分之一（21%）到六分之一（16%）不等，这取决于先前的活检状态。尽管与PI-RADS 4和PI-RADS 5病变相比，这种患病率较低，但仍有相当大比例的男性患有严重疾病。因此，有这种PI-RADS 3病变的男性应该得到适当的治疗。一般来说，临床采用PI-RADS≥4而不是PI-RADS≥3的阈值来选择MRI进行靶向活检的方法不支持我们使用当前csPCa定义的探索性文献检索数据。在主动监测方案中，可以考虑将PI-RADS≥4的阈值与其他临床标志物相结合，其中csPCa缺失的个体风险与重复前列腺活检的持续过程之间的平衡是至关重要的。在未来，磁共振成像和解释的改进，结合分子生物标志物和多变量风险模型都将用于前列腺癌的检测和监测。这些组合将有助于在具有挑战性的情况下做出决策，例如在早期检测时csPCa的诊断结果不明确和模棱两可。
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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