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MRI-guided biopsies and minimally invasive therapy for prostate cancer.

Ghai S, Trachtenberg J - Indian J Urol (2015 Jul-Sep)

Bottom Line: Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa).Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa.Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa.

View Article: PubMed Central - PubMed

Affiliation: Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.

ABSTRACT
Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa). Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa.

No MeSH data available.


Related in: MedlinePlus

Focal therapy templates. Magnetic resonance-guided in-bore ablation is ideally suited for targeted ablation
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Figure 1: Focal therapy templates. Magnetic resonance-guided in-bore ablation is ideally suited for targeted ablation

Mentions: Various experts have proposed different ablative templates for focal therapy [Figure 1], but in our opinion “focal therapy” is somewhat of a misnomer for hemiablation and subtotal zonal ablation templates. The goal of focal therapy should be to perform targeted ablation of the MRI visible index tumor with the aim to eradicate the index lesion and minimizing side-effects of treatment, thereby providing the best balance between oncologic control and maintenance of quality of life (QoL).[15] Visualization of tumor allows in-bore MR-guided focal treatment to be more suitable for targeted ablation and accurate targeting without any misregistration concerns.[37] In-bore treatment also offers the advantage of MR thermometry, which provides real-time monitoring of the thermal map during the treatment to ensure selective and adequate tumor ablation and preservation of sensitive surrounding structures. Contrast-enhanced scan at the end of the procedure shows the non-perfused volume and helps confirm adequate treatment coverage before the patient is taken off the table.


MRI-guided biopsies and minimally invasive therapy for prostate cancer.

Ghai S, Trachtenberg J - Indian J Urol (2015 Jul-Sep)

Focal therapy templates. Magnetic resonance-guided in-bore ablation is ideally suited for targeted ablation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495495&req=5

Figure 1: Focal therapy templates. Magnetic resonance-guided in-bore ablation is ideally suited for targeted ablation
Mentions: Various experts have proposed different ablative templates for focal therapy [Figure 1], but in our opinion “focal therapy” is somewhat of a misnomer for hemiablation and subtotal zonal ablation templates. The goal of focal therapy should be to perform targeted ablation of the MRI visible index tumor with the aim to eradicate the index lesion and minimizing side-effects of treatment, thereby providing the best balance between oncologic control and maintenance of quality of life (QoL).[15] Visualization of tumor allows in-bore MR-guided focal treatment to be more suitable for targeted ablation and accurate targeting without any misregistration concerns.[37] In-bore treatment also offers the advantage of MR thermometry, which provides real-time monitoring of the thermal map during the treatment to ensure selective and adequate tumor ablation and preservation of sensitive surrounding structures. Contrast-enhanced scan at the end of the procedure shows the non-perfused volume and helps confirm adequate treatment coverage before the patient is taken off the table.

Bottom Line: Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa).Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa.Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa.

View Article: PubMed Central - PubMed

Affiliation: Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.

ABSTRACT
Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa). Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa.

No MeSH data available.


Related in: MedlinePlus