Multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging-guided biopsy in the diagnosti
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Michael Chaloupka1 · Maria Apfelbeck1 · Paulo Pfitzinger1 · Robert Bischoff1 · Ekaterina Lellig1 · Lukas Rath1 · Boris Schlenker1 · Christian G. Stief1 · Dirk-André Clevert2 1
Urologische Klinik und Poliklinik des Klinikums der Universität München, Ludwig-Maximilians-Universität Campus Großhadern, Munich, Germany 2 Interdisziplinäres Ultraschallzentrum, Klinik und Poliklinik Radiologie des Klinikums der Universität München, Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany
Multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging-guided biopsy in the diagnostic pathway of prostate cancer Background Prostate cancer is the most prevalent type of cancer and the second most prevalent cause of cancer-related death among men in Germany [1]. Approximately 60,700 men were diagnosed with this disease in 2018 [1]. The average age of diagnosis is around 72 years and the average age of cancer-related death is 79 years [1]. Survival rates for prostate cancer are among the highest of all forms of cancer: 5-year and 10-year survival rates are 91% and 90%, respectively [1]. However, these numbers hide the heterogeneity of this disease. Patients diagnosed with highrisk prostate cancer have a high chance of recurrence after initial treatment and development of metastases [2]. These patients are likely to require multimodal therapy involving surgery, radiation therapy and chemotherapy. A randomized controlled trial by Bill-Axelson et al. that assigned patients with localized prostate cancer to either radical prostatectomy or watchful waiting showed that, after a follow-up of 29 years, patients with extracapsular extension in the specimen of radical prostatectomy had a five times higher chance of death from prostate cancer compared to patients without extra-
capsular extension. Patients with a Gleason grade higher than 7 had a 10 times higher chance of death from prostate cancer than patients with Gleason grade 6 [3]. On the other hand, the current literature shows that, in consideration of the average age of diagnosis, the life expectancy of patients with low-risk prostate cancer is often unaltered and that these patients are often unlikely to experience symptoms during the process of the disease. Bill-Axelson et al. also showed that, after a follow-up of 29 years, patients benefited from radical prostatectomy with a mean of 2.9 years of lifetime gained compared to patients under watchful waiting. The recently published update results of the PROTECT trial by Hamdy et al., who randomly assigned patients to either radical prostatectomy, radiation therapy or prostate-specific antigen (PSA) monitoring, showed that patients with localized Gleason 6 prostate cancer had a cancerspecific mortality of less than 1% after 10year follow-up. The incidence of metastases was only 3.5% [4]. Treating patients with the same form of curative therapy, e.g. radical prostatectomy or radiation therapy regardless of their risk classification would result in overtreatment of a large cohort of patients with unneces-
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