Rethinking prostate cancer screening: could MRI be an alternative screening test?
Rethinking prostate cancer screening: could MRI be an alternative screening test?
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DOI：
10.1038/s41585-020-0356-2
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发表时间：
2020-07-21
影响因子：
15.3
通讯作者：
Ahmed, Hashim U.
中科院分区：
文献类型：
--
作者：
Eldred-Evans, David;Tam, Henry;Ahmed, Hashim U.
在这里，作者描述了一种理想的前列腺癌筛查试验的特征，并研究了为什么PSA不能满足这些特征。他们讨论了一个简短的MRI方案是否可以作为前列腺癌的替代或额外的筛查测试，并探讨了其固有的挑战和潜在的解决方案。在过去的十年里，关于以人群为基础的前列腺癌筛查发生了激烈的争论。虽然通过血清PSA水平进行筛查可以降低前列腺癌特异性死亡率，但目前尚不清楚其益处是否超过假阳性结果和轻微前列腺癌过度诊断的风险，因此不推荐用于基于人群的筛查。MRI对前列腺癌的筛查可能类似于乳房x光检查对乳腺癌的筛查或低剂量CT对肺癌的筛查。为了执行这一方案，需要克服一些潜在的障碍和技术挑战。我们讨论了可以解决这些挑战的不同MRI筛查方法，包括缩短MRI方案，靶向MRI筛查，更长的重新筛查间隔和多模式筛查途径。这些方法需要进一步的研究，我们提出了一个分阶段逐步的研究框架，以确保正确评估快速MRI检查作为前列腺癌筛查试验的使用。
Here, the authors describe the characteristics of an ideal screening test for prostate cancer and examine why PSA fails to meet these attributes. They discuss whether an abbreviated MRI protocol could be an alternative or additional screening test for prostate cancer and explore its inherent challenges and potential solutions.In the past decade rigorous debate has taken place about population-based screening for prostate cancer. Although screening by serum PSA levels can reduce prostate cancer-specific mortality, it is unclear whether the benefits outweigh the risks of false-positive results and overdiagnosis of insignificant prostate cancer, and it is not recommended for population-based screening. MRI screening for prostate cancer has the potential to be analogous to mammography for breast cancer or low-dose CT for lung cancer. A number of potential barriers and technical challenges need to be overcome in order to implement such a programme. We discuss different approaches to MRI screening that could address these challenges, including abbreviated MRI protocols, targeted MRI screening, longer rescreening intervals and a multi-modal screening pathway. These approaches need further investigation, and we propose a phased stepwise research framework to ensure proper evaluation of the use of a fast MRI examination as a screening test for prostate cancer.