MRI Conspicuity of Prostate Cancer: Investigating Clinically Significant Prostate Cancer Not Detected by Multiparametric MRI

前列腺癌的 MRI 显着性：调查多参数 MRI 未检测到的具有临床意义的前列腺癌

• 批准号: MR/S00680X/1
• 负责人: Joseph Norris
• 金额: $ 29.1万
• 依托单位: University College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS00680X%2F1
• 关键词: MRI; Conspicuity; Prostate; Cancer; Investigating

In the UK, the burden of prostate cancer continues to saw. Over 47,000 men are diagnosed with the disease each year and it has recently overtaken breast cancer in terms of cancer-related deaths. However, the severity of prostate cancer varies greatly, and in order for men to receive the most appropriate treatment, it is essential that they be given a timely and accurate diagnosis.Traditionally, prostate cancer is diagnosed in men with an abnormal blood test (prostate specific antigen; PSA) or an abnormal feeling prostate, after an examination through the back passage. These men then undergo a biopsy, in which samples of prostate tissue are taken. These samples are analysed under the microscope to assess for the presence or absence of prostate cancer. The location of where samples are taken from is not influenced by knowledge of where the cancer is, and the standard way in which the biopsies are taken is often termed 'random.' Random biopsy risks missing aggressive prostate cancer and risks diagnosing prostate cancers that are not very aggressive at all (thereby triggering treatment, when it is not needed). To overcome this haphazard approach, we have now begun to introduce MRI scans before men have their prostate biopsied. This has brought a collection of benefits, including being able to see whether a cancer is present or not (and therefore whether a man needs a biopsy or not) and also seeing where the cancer is, how large it is, and how many tumours are present. The advantages are clear, and two large recent research studies have shown that MRI scans are highly accurate at detecting cancer, and can help save many men from painful biopsies which carry risks such as blood in the urine, blood in the semen and infection requiring admission to hospital. These research studies have also shown that by using new MRI scans to help guide where we biopsy, we are able to pick-up more of the aggressive cancers and less of the non-aggressive cancers (compared to the traditional approach).These findings are very encouraging for the future, however, there are still occasions in which MRI scans can miss prostate cancer, and the reason this happens is not well understood. The main aim of our research is to discover and understand which prostate cancers are not detected by MRI. If we can understand the features that these cancers have, we may be able to work out reasons that they are not detected. We may also be able to make a decision about whether or not this truly matters - it is possible that MRI only misses non-aggressive cancers that we do not need to be concerned about. On the other hand, if MRI scans miss aggressive cancer, then this could be a serious problem, as the cancer would be liable to spread before it is detected. The truth is, we do not know a lot about these prostate cancers, and so there is a very strong need for this research.This research project will be conducted at University College London, which is world-respected in this field. The plan is to look carefully, in different ways, at cancers that are not detected. By scrutinising their MRI scans and biopsies, we hope find out their characteristics, and ultimately, reasons for why they were overlooked in the first place. Building on this, we then may even be able to work out additional ways to find these tricky tumours.In addition to occasionally missing prostate cancer, MRI does have another problem. Roughly half of all cases that are suggestive of cancer on MRI turn out to be benign conditions on biopsy. Traditionally this is attributed to infection, however, the true reasons for this have not been clearly explained. So in addition to the cancer that is missed, this study will examine cases in which the MRI scan showed cancer to be present, but that in actual fact was not there when the prostate was biopsied. We will examine these cases carefully to help find out what aspects caused an inappropriately suspicious appearance on MRI. Again, if we can do

在英国，前列腺癌的负担继续增加。每年有超过47,000名男子被诊断患有这种疾病，就癌症相关死亡人数而言，它最近超过了乳腺癌。然而，前列腺癌的严重程度差别很大，为了让男性接受最适当的治疗，及时准确的诊断是至关重要的。传统上，前列腺癌被诊断为血液检查异常（前列腺特异性抗原；PSA）或前列腺感觉异常，通过背部通道检查。然后，这些人接受活组织检查，提取前列腺组织样本。这些样本在显微镜下进行分析，以评估前列腺癌的存在与否。从哪里提取样本并不受癌症所在位置的影响，而活检的标准方法通常被称为“随机”。随机活检有可能遗漏侵袭性前列腺癌，也有可能诊断出根本不具侵袭性的前列腺癌（因此在不需要的时候引发治疗）。为了克服这种随意的方法，我们现在已经开始在男性进行前列腺活检之前引入核磁共振扫描。这带来了一系列的好处，包括能够看到癌症是否存在（因此一个人是否需要活检），也可以看到癌症在哪里，有多大，有多少肿瘤存在。其优势是显而易见的，最近的两项大型研究表明，核磁共振成像扫描在检测癌症方面非常准确，可以帮助许多男性避免痛苦的活组织检查，因为活组织检查有尿中带血、精液中带血和感染等风险，需要入院治疗。这些研究还表明，通过使用新的MRI扫描来帮助指导活检的位置，我们能够发现更多的侵袭性癌症和更少的非侵袭性癌症（与传统方法相比）。这些发现对未来是非常鼓舞人心的，然而，在某些情况下，核磁共振扫描可能会遗漏前列腺癌，而这种情况发生的原因尚不清楚。我们研究的主要目的是发现和了解哪些前列腺癌没有被MRI检测到。如果我们能够了解这些癌症的特征，我们也许能够找出它们没有被发现的原因。我们也可以决定这是否真的重要——MRI可能只会遗漏我们不需要担心的非侵袭性癌症。另一方面，如果核磁共振扫描没有发现侵袭性癌症，那么这可能是一个严重的问题，因为癌症可能在被发现之前就已经扩散了。事实是，我们对这些前列腺癌了解不多，所以这项研究非常有必要。这个研究项目将在伦敦大学学院进行，伦敦大学学院在该领域享有盛誉。该计划是用不同的方法仔细观察未被发现的癌症。通过仔细检查他们的核磁共振扫描和活组织检查，我们希望找出他们的特征，并最终找出他们最初被忽视的原因。在此基础上，我们甚至可以找到其他方法来发现这些棘手的肿瘤。除了偶尔会遗漏前列腺癌，核磁共振成像还有另一个问题。在MRI上显示为癌症的病例中，大约有一半的活检结果是良性的。传统上，这归因于感染，然而，其真正原因尚未得到明确解释。因此，除了那些被遗漏的癌症，这项研究还将研究那些核磁共振扫描显示癌症存在，但实际上前列腺活检时并不存在的病例。我们将仔细检查这些病例，以帮助找出哪些方面导致MRI上不适当的可疑外观。如果我们能

项目成果

Re: Giorgio Gandaglia, Guillaume Ploussard, Massimo Valerio, et al. Prognostic Implications of Multiparametric Magnetic Resonance Imaging and Concomitant Systematic Biopsy in Predicting Biochemical Recurrence After Radical Prostatectomy in Prostate Cancer Patients Diagnosed with Magnetic Resonance Imaging-targeted Biopsy. Eur Urol Oncol 2020;7:739-47.

回复：Giorgio Gandaglia、Guillaume Ploussard、Massimo Valerio 等人。

• DOI: 10.1016/j.euo.2020.12.015
• 发表时间: 2021
• 期刊: European urology oncology
• 影响因子: 8.2
• 作者: Morka N

The importance of lesion conspicuity in prostate cancer risk assessment

病变显着性在前列腺癌风险评估中的重要性

• DOI: 10.1016/s2666-1683(22)00760-1
• 发表时间: 2022
• 期刊: European Urology Open Science
• 影响因子: 2.5
• 作者: Emberton M

Developments in MRI-targeted prostate biopsy.

• DOI: 10.1097/mou.0000000000000683
• 发表时间: 2020-01
• 期刊: Current Opinion in Urology
• 影响因子: 2.5
• 作者: J. Norris;A. Kinnaird;D. Margolis;A. Padhani;J. Walz;V. Kasivisvanathan