Prostat kanserinin aktif izleminde multiparametrik manyetik rezonans görüntüleme: literatür gözden geçirilmesi

Abstract

Günümüzde aktif izlem, düşük riskli prostat kanserine sahip erkeklerde küratif tedaviye alternatif ve kabul edilebilir bir yönetim olarak popülerlik kazanmıştır. Aktif izlem, hastaya gerekli olmayan müdahalelerden kaçınmayı veya önlemeyi, böylece aşırı tedaviyle ilişkili morbiditeyi azaltmayı amaçlar. Güncel kılavuzlarda aktif izlem yaygın olarak kabul görmesine rağmen hem doktor hem de hasta için ileri evre hastalık ve tekrarlayan biyopsi gereksinimi endişesini ortadan kaldıramamaktadır. Bu durum, aktif izlem protokolünde hastalığın durumu hakkında fikir verebilecek, non-invaziv bir yöntem ihtiyacını ortaya çıkarmaktadır. Görüntüleme yöntemlerindeki son teknolojik gelişmeler, modern anatomik ve fonksiyonel sekansların tanımlanması, prostat kanserinin saptanması, risk değerlendirmesi ve takibinde multiparametrik manyetik rezonans görüntülemenin (mpMRG) artan bir role sahip olmasını sağlamıştır. MpMRG'nin başlıca avantajları, üstün anatomik ve kontrast çözünürlüğüne sahip olması, iyonize radyasyonun olmaması ve multi-planar görüntüleme özelliğinin olmasıdır. Ayrıca mpMRG'de PIRADS sınıflaması, prostat kanserinin raporlanmasındaki standardizasyonu sağlamakta ve radyologlar arasındaki yorumlara olan güvenilirliği artırarak avantaj sağlamaktadır. Bu derleme, prostat kanserinin aktif izleminde güncel bilgiler ışığında mpMRG’nin rolünü değerlendirmeyi ve özetlemeyi amaçlamaktadır.

Keywords

• aktif izlem
• prostat kanseri
• multiparametrik manyetik rezonans görüntüleme

Active surveillance of prostate cancer with multiparametric magnetic resonance imaging: Review of the literature

Abstract

Nowadays, active surveillance has gained popularity as an acceptable management alternative to definitive treatment for men with low-risk prostate cancer. Active surveillance aims to delay or prevent unnecessary interventions – thereby reducing the morbidity associated with overtreatment. Despite widespread acceptance from current guidelines, active surveillance does not eliminate the concern that the advanced disease and repeat biopsy anxiety for both the clinician and the patient. This situation leads to the search for a method that is non-invasive and can give an idea to the clinician about the status of the disease in the active surveillance protocol. Recent technological advancements and the introduction of modern anatomical and functional sequences have led to a growing role for multiparametric magnetic resonance imaging (mpMRI) in the detection, risk assessment, and monitoring of prostate cancer. The main advantages of MRI are its superior anatomic and contrast resolution, lack of ionizing radiation, and multi-planar capabilities. In addition, standardization of reporting findings such as PI-RADS in mpMRI in prostate cancer provides an advantage by increasing inter-reader reliability among radiologists. This review aims to evaluate and summarize the role of magnetic resonance imaging in the active surveillance of prostate cancer.

Keywords

• active surveilliance
• prostate cancer
• multiparametric magnetic resonance imaging

References

1. 1. Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol. 2020;77(1):38-52. DOI: 10.1016/j.eururo.2019.08.005
2. 2. Sung H, Ferlay J, Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.
3. 3. Miller DC, Gruber SB, Hollenbeck BK, Montie JE, Wei JT. Incidence of initial local therapy among men with lower-risk prostate cancer in the United States. J Natl Cancer Inst. 2006;16;98(16):1134-41.
4. 4. Lam TBL, MacLennan S, Willemse PM et al. EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study). Eur Urol. 2019;76(6):790-813.
5. 5. Tosoian JJ, Mamawala M, Epstein JI et al. Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer. J Clin Oncol. 2015;20;33(30):3379-85.
6. 6. Klotz L, Vesprini D, Sethukavalan P et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;20;33(3):272-7.
7. 7. Jain S, Loblaw A, Vesprini D et al. Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort. J Urol. 2015;194(1):79-84.
8. 8. An JY, Sidana A, Choyke PL et al. Multiparametric Magnetic Resonance Imaging for Active Surveillance of Prostate Cancer. Balkan Med J. 2017;29;34(5):388-396.

9. 9. Barrett T, Rajesh A, Rosenkrantz AB, Choyke PL, Turkbey B. PI-RADS version 2.1: one small step for prostate MRI. Clin Radiol. 2019;74(11):841-852.
10. 10. Schouten MG, Hoeks CM, Bomers JG et al. Location of Prostate Cancers Determined by Multiparametric and MRI-Guided Biopsy in Patients With Elevated Prostate-Specific Antigen Level and at Least One Negative Transrectal Ultrasound-Guided Biopsy. AJR Am J Roentgenol. 2015;205(1):57-63.
11. 11. Weerakoon M, Papa N, Lawrentschuk N et al. The current use of active surveillance in an Australian cohort of men: a pattern of care analysis from the Victorian Prostate Cancer Registry. BJU Int. 2015;115 Suppl 5:50-6.
12. 12. Alam R, Carter HB, Landis P, Epstein JI, Mamawala M. Conditional probability of reclassification in an active surveillance program for prostate cancer. J Urol. 2015;193(6):1950-5.
13. 13. Xu N, Wu YP, Li XD et al. Risk of upgrading from prostate biopsy to radical prostatectomy pathology: Is magnetic resonance imaging-guided biopsy more accurate? J Cancer. 2018;8;9(19):3634-3639.
14. 14. Siddiqui MM, Rais-Bahrami S, Truong H et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol. 2013;64(5):713-719.
15. 15. Goel S, Shoag JE, Gross MD et al. Concordance Between Biopsy and Radical Prostatectomy Pathology in the Era of Targeted Biopsy: A Systematic Review and Meta-analysis. Eur Urol Oncol. 2020;3(1):10-20.
16. 16. Vargas HA, Akin O, Afaq A et al. Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol. 2012;188(5):1732-8.
17. 17. Barkovich EJ, Shankar PR, Westphalen AC. A Systematic Review of the Existing Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) Literature and Subset Meta-Analysis of PI-RADSv2 Categories Stratified by Gleason Scores. AJR Am J Roentgenol. 2019;212(4):847-854.
18. 18. Felker ER, Wu J, Natarajan S et al. Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental Value. J Urol. 2016;195(5):1421-1427.
19. 19. Schoots IG, Nieboer D, Giganti F et al. Is magnetic resonance imaging-targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low-risk prostate cancer? A systematic review and meta-analysis. BJU Int. 2018;122(6):946-958.
20. 20. Rosenkrantz AB, Verma S, Choyke P et al. Prostate Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Patients with a Prior Negative Biopsy: A Consensus Statement by AUA and SAR. J Urol. 2016;196(6):1613-1618. 21. Weinreb JC, Barentsz JO, Choyke PL et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016;69(1):16-40.
21. 22. Klotz L, Loblaw A, Sugar L et al. Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial. Eur Urol. 2019;75(2):300-309.
22. 23. Womble PR, Montie JE, Ye Z et al. Michigan Urological Surgery Improvement Collaborative. Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer. Eur Urol. 2015;67(1):44-50.
23. 24. Lee EK, Baack J, Penn H et al. Active surveillance for prostate cancer in a veteran population. Can J Urol. 2010;17(6):5429-35.
24. 25. Glass AS, Dall'Era MA. Use of multiparametric magnetic resonance imaging in prostate cancer active surveillance. BJU Int. 2019;124(5):730-737.