Active monitoring of prostate cancer with multiparametric magnetic resonance imaging: present and future perspectives
Buzogány István dr., Dombóvári Péter dr., Ráfi Tamás dr.,Vrecenár László dr., Beöthe Tamás dr.
Dél-pesti Centrum Korházak, Péterfy Kórház Rendelőintézet Manninger Jenő Országos Traumatológiai Intézet Urológiai Osztály, Budapest (osztályvezető: Buzogány István dr.)
Over the last ten years, active surveillance (AS) has become increasingly applied for patients with low-risk prostate cancer. Appropriately selected AS patients have a 10-year prostate cancer-specific survival (PCSS) approaching 99%. Therefore, some international and domestic institutions have expanded the inclusion criteria for AS to avoid the unnecessary morbidity associated with overtreatment. Although statistical methods of data provision and processing were heterogeneous across the relevant AS studies, data from several high-evidence studies was compared to reach the final agreement in the Detective and Redeem consensus studies. Patients with histologically confirmed PCa are eligible for AS programme when the following criteria are met: PSA Among patients with a Gleason score of 3+4=7, ISUP 2, AS programme may be started only when low numbers of positive cores are present with a PSA 10 ng/ml, Gleason score of ≥4+3=7, ISUP 3, clinical stage >cT2a and pathological features of the tumour include any of the following: dominant ductal carcinoma (including pure intraductal carcinoma), sarcomatoid carcinoma, small cell carcinoma, tumour involving or spreading through the prostatic capsule, and lymphovascular or perineural invasion. As multiparametric MRI (mpMRI) scans are becoming more widespread in daily practice, AS protocols based on uniform principles are being followed, it has proven to be safe to keep patients under close observation without unnecessary rebiopsies. Since the introduction of mpMRI fusion histological sampling, the cancer detection rate has also improved significantly. Although the implementation of AS has increased the number of PCa patients who are safely observed with active surveillance, there are still too many people undergoing curative therapy prematurely, resulting in overtreatment. Additional research on genetic tests and clinical parameters such as multiparametric magnetic resonance imaging (mpMRI) are needed to further refine therapeutic groups.