ImportanceActive surveillance (AS) has become an increasingly important option for managing low-risk and select intermediate-risk prostate cancer. Although imaging, particularly multiparametric magnetic resonance imaging (mpMRI), has emerged in the prebiopsy pathway for the diagnosis of prostate cancer, the role of mpMRI in patient selection for AS and the necessity of prostate biopsies during AS remain poorly defined. Despite well-founded biopsy schedules, there has been substantial investigation into whether imaging may supplant the need for prostate biopsies during AS. This review aimed to summarize the contemporary role of imaging in the diagnosis and surveillance of prostate cancer.ObservationsMultiparametric MRI is the most established form of imaging in prostate cancer, with routine prebiopsy use being shown to help urologists distinguish between clinically significant and clinically insignificant disease. The visibility of these lesions on mpMRI closely correlates with their behavior, with visible disease portending a worse prognosis. Combined with other clinical data, risk calculators may better delineate patients with higher-risk disease and exclude them from undergoing AS. While current evidence suggests that mpMRI cannot replace the need for prostate biopsy during AS due to the possibility of missing higher-risk disease, the addition of prostate biomarkers may help to reduce the frequency of these biopsies. The role of prostate-specific antigen positron emission tomography/computed tomography is still emerging but has shown promising early results as an adjunct to mpMRI in initial diagnosis.Conclusions and RelevanceImaging in prostate cancer helps to better select patients appropriate for AS, and future studies may strengthen the predictive capabilities of risk calculators. Multiparametric MRI has been shown to be imperative to rationalizing biopsies for patients enrolled in AS. However, heterogeneity in the evidence of mpMRI during AS has suggested that further prospective studies and randomized clinical trials, particularly in homogenizing reporting standards, may reveal a more defined role in monitoring disease progression.

中文翻译：

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前列腺癌诊断和主动监测中的影像学检查


重要性主动监测 （AS） 已成为管理低风险和特定中等风险前列腺癌的越来越重要的选择。尽管影像学检查，特别是多参数磁共振成像 （mpMRI） 已出现在前列腺癌诊断的活检前途径中，但 mpMRI 在 AS 患者选择中的作用以及 AS 期间前列腺活检的必要性仍不明确。尽管活检计划有充分依据，但关于 AS 期间影像学检查是否可能取代前列腺活检的需求，已经进行了大量调查。本综述旨在总结影像学检查在前列腺癌诊断和监测中的当代作用。观察多参数 MRI 是前列腺癌中最成熟的成像形式，常规活检前检查被证明可以帮助泌尿科医生区分有临床意义和无临床意义的疾病。这些病变在 mpMRI 上的可见度与其行为密切相关，可见的疾病预示着更糟糕的预后。结合其他临床数据，风险计算器可以更好地描述患有高风险疾病的患者，并将他们排除在接受 AS 之外。虽然目前的证据表明，由于可能漏诊高风险疾病，mpMRI 不能取代 AS 期间对前列腺活检的需求，但添加前列腺生物标志物可能有助于降低这些活检的频率。前列腺特异性抗原正电子发射计算机断层扫描/计算机断层扫描的作用仍在显现，但作为 mpMRI 在初始诊断中的辅助治疗，已显示出有希望的早期结果。结论和相关性前列腺癌的成像有助于更好地选择适合 AS 的患者，未来的研究可能会加强风险计算器的预测能力。多参数 MRI 已被证明对于为 AS 入组患者进行活检合理化是必不可少的。然而，AS 期间 mpMRI 证据的异质性表明，进一步的前瞻性研究和随机临床试验，特别是在同质化报告标准方面，可能揭示在监测疾病进展方面更明确的作用。