Modernizing the diagnostic and decision-making pathway for prostate cancer - Abstract

PSA has lead to a drastic increase in the detection of prostate cancer, rendering this biomarker the gateway for the diagnostic pathway of prostatic neoplasms.

However, the increase in incidence has not been mirrored by a similar reduction in mortality. Widespread PSA testing has facilitated over-diagnosis and over-treatment of indolent disease. To reduce this phenomenon and avoid negative repercussions on the quality-of-life of men undergoing unnecessary therapies, the diagnostic pathway of prostate cancer needs to be improved. Multi-parametric MRI (mp-MRI) can enhance sensitivity and specificity of PSA as well as the shortcomings of random biopsy sampling. This novel imaging technique has been proven to identify larger and more aggressive cancer foci, which should be targeted for treatment. New technological developments now allow for fusion of mp-MRI images with real-time ultrasound, opening the way to lesion-targeted biopsies. Furthermore, mp-MRI and targeted biopsies can also improve active surveillance protocols and permit more conservative focal therapy strategies. By implementing targeted biopsies, the diagnostic pathway will focus on clinically significant disease, consequently reducing over-diagnosis and over-treatment. Before this novel protocol becomes the new gold-standard, mp-MRI acquisition and interpretation need to be standardized and targeted-biopsy strategies need to be further validated prior to abandoning random-sampling ones. Several multi-disciplinary consortiums are already working on standardization of prostate MRI and there are ongoing prospective trials on targeted biopsies and MRI. Soon imaging of prostatic lesions and selected biopsies will modify the diagnostic evaluation of prostate cancer, reducing over-treatment and therapy-derived complications that negatively affect quality of life.

Written by:
Polascik TJ, Passoni NM, Villers A, Choyke PL.   Are you the author?
Duke University Medical Center; Urology, Duke Cancer Institute; Urology, CHU Lille, University Lille Nord de France; Molecular Imaging Program, NCI/NIH.  

Reference: Clin Cancer Res. 2014 Oct 14. pii: clincanres.0247.2014.
doi: 10.1158/1078-0432.CCR-14-0247

PubMed Abstract
PMID: 25316814 Prostate Cancer Section