All change in the prostate cancer diagnostic pathway.,Nature Reviews Clinical Oncology

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All change in the prostate cancer diagnostic pathway.
Nature Reviews Clinical Oncology ( IF 81.1 ) Pub Date : 2020-02-28 , DOI: 10.1038/s41571-020-0332-z
Derek J Lomas _{1,

2,

3} , Hashim U Ahmed _{2,

3}

Affiliation

Following detection of high levels of serum prostate-specific antigen, many men are advised to have transrectal ultrasound-guided biopsy in an attempt to locate a cancer. This nontargeted approach lacks accuracy and carries a small risk of potentially life-threatening sepsis. Worse still, it can detect clinically insignificant cancer cells, which are unlikely to be the origin of advanced-stage disease. The detection of these indolent cancer cells has led to overdiagnosis, one of the major problems of contemporary medicine, whereby many men with clinically insignificant disease are advised to undergo unnecessary radical surgery or radiotherapy. Advances in imaging and biomarker discovery have led to a revolution in prostate cancer diagnosis, and nontargeted prostate biopsies should become obsolete. In this Perspective article, we describe the current diagnostic pathway for prostate cancer, which relies on nontargeted biopsies, and the problems linked to this pathway. We then discuss the utility of prebiopsy multiparametric MRI and novel tumour markers. Finally, we comment on how the incorporation of these advances into a new diagnostic pathway will affect the current risk-stratification system and explore future challenges.

中文翻译：

前列腺癌诊断途径的所有变化。

在检测到高水平的血清前列腺特异性抗原后，建议许多男性进行经直肠超声引导活检以试图定位癌症。这种无针对性的方法缺乏准确性，并且有可能危及生命的败血症的风险很小。更糟糕的是，它可以检测出临床上无关紧要的癌细胞，这些癌细胞不太可能是晚期疾病的起源。这些惰性癌细胞的检测导致了过度诊断，这是当代医学的主要问题之一，因此建议许多临床上无明显疾病的男性进行不必要的根治性手术或放疗。成像和生物标志物发现的进步导致了前列腺癌诊断的革命，非靶向前列腺活检应该过时了。在这篇透视文章中，我们描述了目前依赖于非靶向活检的前列腺癌诊断途径，以及与该途径相关的问题。然后我们讨论活检前多参数 MRI 和新型肿瘤标志物的效用。最后，我们评论将这些进展纳入新的诊断途径将如何影响当前的风险分层系统并探索未来的挑战。

更新日期：2020-02-28

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