Multiparametrische MRT der Prostata: Methode zur Früherkennung des Prostatakarzinoms?

Zusammenfassung

Die Maßnahmen zur Früherkennung, bzw. zum Screening des Prostatakarzinoms werden derzeit kontrovers diskutiert, da die Erkrankung durch eine hohe Inzidenz bei relativ geringer Mortalität, Verfügbarkeit von nur wenig sicheren Prognosemarkern und nach wie vor therapiebedingter Morbidität gekennzeichnet ist. Die konventionelle, morphologische MRT alleine spielt für die Früherkennung sicherlich keine Rolle, da kleine Tumorherde der Darstellung entgehen. Bei klinischem Verdacht auf das Vorliegen eines Prostatakarzinoms ist jedoch die multiparametrische MRT das derzeit empfindlichste Verfahren, suspekte Herdbefunde in der Prostata zu detektieren und hinsichtlich ihrer Malignität zu charakterisieren. Von besonderer Bedeutung ist auch die Möglichkeit der Identifikation sogenannter „Indexläsion” in der Prostata, d. h. Tumorareale mit dem höchsten Malignitätsgrad, die das therapeutische Vorgehen bestimmt. Diese Information kann die Genauigkeit der Prostatastanzbiopsie verbessern und als Biomarker zur Verlaufsbeurteilung bei „Active Surveillance” dienen. Die Methode kann damit einen wichtigen Beitrag zur dringend erforderlichen Trennung von klinisch signifikanten und nicht signifikanten Karzinomen liefern.

Abstract

Current approaches for the early detection of prostate cancer are controversially discussed because the disease is characterized by a high incidence rate with a relatively low morbidity rate, availability of only limited prognostic markers, and continued therapy-related morbidity. Conventional morphological MRI does not play a role in early detection since small tumor foci cannot be delineated. However, if there is clinical suspicion for prostate cancer, multiparametric MRI is currently the most accurate method for detecting and characterizing suspicious lesions in the prostate. The potential to identify the so-called ”index lesion”, i. e., the tumor area that is most aggressive and determines treatment, is particularly important. This information can increase the accuracy of prostate biopsy and serve as a biomarker for follow-up during active surveillance. The method may considerably contribute to the urgently required separation of clinically significant from clinically insignificant prostate cancers.

Key words

prostate - MR functional imaging - screening

Literatur

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