An international team of experts on imaging prostate cancer participated in a review of the literature on prostate MRI and active surveillance.[i] To give you an idea of how impressive the team was, here is a list of the institutions they represent:
- Erasmus University Medical Center (Depts. of Urology and Radiology), Rotterday, the Netherlands
- University College London (Div. of Surgical & Interventional Science), London, UK
- University College London Hospital (Depts. of Urology and Radiology)
- San Raffaele Scientific Institute (Dept. of Radiology & Centre for Experimental Imaging), Milan, Ital
- Helsinki University Central Hospital (Dept. of Urology), Finland
- Sunnybrook Hospital (Dept. of Urology), Toronto, Ontario, Canada
- CHU Lille/Université Lille Nord de France (Dept. of Urology), Lille, France
- Sahlgrenska Academy/University of Göteborg, Sweden
Some of the authors’ names might be more familiar than others, such as Laurence Klotz, Caroline Moore, Arnauld Villers. In any case, the authors represent a powerhouse of knowledge and science when it comes to prostate cancer and imaging.
In searching the existing published data on how MRI is utilized to help determine candidates for active surveillance, the authors summed up their findings in a statement that MRI is useful in detecting clinically significant prostate cancer in men who are thinking of going on active surveillance: “MRI at the start of surveillance can detect clinically significant disease in one-third to half of men.” This is important, as many men who are considering holding off on treatment may not be sleep well at night thinking they might have a more aggressive disease than their biopsy found. Or, they may wish to have an MRI-guided targeted biopsy into the suspicious lesion before deciding on surveillance.
The authors also wrote that, based on their literature search, there was insufficient data on the use of MRI to monitor patients who are already on active surveillance so they call for more research: “… there is a need to define significant disease on MRI and significant changes over time.”
My personal take on this review article is that it shows that global authorities on prostate cancer imaging are pursuing MRI utility with regard to this disease, and conservatively promoting it using the methodologies and language acceptable to their scientific peers. In other words, getting their literature review published was a strategic way to spread the good news about prostate MRI.
[i] Schools IG, Petrides N, Giganti F et al. Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol. 2014 Nov 15. pii: S0302-2838(14)01166-X.