MRI ?, Mp-MRI ? in diagnosis and radiotherapy planning in a patient with prostate cancer (original) (raw)

International braz j urol

To the editor, Prostate cancer (PC) has a highly variable clinic. It can remain for an extended period of time without any findings, as well as shows an aggressive course. Early diagnosis is very important. The most important diagnostic methods used in the PC are digital rectal examination, transrectal ultrasonography and prostate specific antigen (PSA) values. The exact diagnosis is made by histopathology (1). The correct staging of the PC is very important as it directly affects the treatment decision and patient management. Currently, staging tests are not recommended since the risk of metastasis is low in patients with low risk compared to D'Amico risk classification. It is recommended that patients in the middle-high risk group be performed by abdominal computer tomography (CT) or magnetic resonance imaging (MRI) with bone scintigraphy for staging (2-4). Since the 1980s, MRI has been used in the evaluation of the prostate gland and its surrounding structures among radiological diagnostic methods. It was originally used for staging in patients with PC diagnosis, and for determining invasion and lymph node metastases. Conventional MRI examinations (especially T2-weighted examinations) are the basic method for detecting PC, but they have high sensitivity but low specificity (2). In recent years, new software and techniques in MRI technique have made progress in anatomical, functional and physiological evaluation. Thus, the evaluation has increased sensitivity and specificity. In addition to high-resolution T2A examinations, dynamic, diffusion and MRI spectroscopies have been added to the diagnosis of PC. The MRI technique performed by adding at least two functional MRIs to the T2A sequences is called Multiparametric MRI (Mp-MRI). This method is the most commonly used technique for prostate imaging today. It is especially recommended to use MRI device with 3 Tesla main magnet power in imaging. Compared to 1.5T tesla devices, the signal-to-noise ratio, temporal and spatial resolution are higher in 3T devices. Biopsies can be taken from the lesion described in the light of Mp-MRI, and this reduces false negative rates (4-6). One of the most important benefits of Mp-MRI is its extraprostatic extension and local recurrence. Because the extension outside the capsule and the seminal vesicle involvement counted in the extraprostatic extension criterion are independent pathological criteria that increase the risk of local recurrence, progression and death. The probability of local recurrence in these cases considered high risk is 40-50% (6, 7). According to the meta-analysis of 5681 cases by de Rooij et al; in extracapsular invasion, MRI sensitivity and specificity were found to be 57% and 91%, respectively (2). In a study by Pokorny et al. they compared transrectal ultrasound guided biopsy and MP-MRI guided biopsy. They found that the MP-MRI examination reduced the biopsy requirement by 51%. They also reported that the MP-MRI examination reduced the clinical significance of low prostate cancer by 89.4% and increased the detection of medium / high risk prostate cancer by 17.7%. (3). In a review, it is stated that Mp-MRI is found to be highly specific and highly sensitive in detecting local recurrences and in the diagnosis of