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Role of MRI in low-risk prostate cancer: finding the wolf in sheep's clothing or the sheep in wolf's clothing?

Schoots, IG; Moore, CM; Rouvière, O; (2017) Role of MRI in low-risk prostate cancer: finding the wolf in sheep's clothing or the sheep in wolf's clothing? Current Opinion in Urology , 27 (3) pp. 238-245. 10.1097/MOU.0000000000000397. Green open access

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Abstract

PURPOSE OF REVIEW: In men on active surveillance for localized prostate cancer, MRI and MRI-targeted biopsies can be used prior to confirmatory or surveillance biopsy, to detect individuals with high-grade cancer (the wolf in sheep's clothing). However, some men will have low-risk disease despite adverse MRI findings (the sheep in wolf's clothing). We review the value addition of MRI-targeted biopsies in comparison to systematic transrectal ultrasound-guided biopsies, using pathological reclassification as an end-point. RECENT FINDINGS: At confirmatory and surveillance biopsies, both the MRI-targeted and repeat standard biopsies have shown value in identifying histologically adverse findings in men with low-risk prostate cancer. For maximal detection of clinically significant cancer, a prebiopsy MRI should be performed together with both MRI-targeted and systematic transrectal ultrasound-guided biopsies. Stable disease on MRI may reduce the need for serial biopsies in some men on active surveillance. SUMMARY: Prostate MRI and subsequent MRI-targeted biopsies are worthwhile to the current management of men with low-risk prostate cancer on active surveillance. Prostate MRI, in combination with a multivariable risk-prediction model may help in identifying both the wolf in sheep's clothing and the sheep in wolf's clothing, and in potentially reducing the need for serial biopsies.

Type: Article
Title: Role of MRI in low-risk prostate cancer: finding the wolf in sheep's clothing or the sheep in wolf's clothing?
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/MOU.0000000000000397
Publisher version: http://doi.org/10.1097/MOU.0000000000000397
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: active surveillance, biopsies, monitoring, MRI, prostate cancer, risk prediction, systematic review
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/1549698
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