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Prostatakarzinom

Prostate cancer

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Zusammenfassung

Für viele klinische Fragestellungen zum Prostatakarzinom wird die Magnetresonanztomographie (MRT) der Prostata immer wichtiger. Die hohe morphologische Auflösung von T2w-Sequenzen ist im Vergleich zu anderen Bildgebungsmodalitäten unübertroffen und ermöglicht neben Detektion und Lokalisation des Prostatakarzinoms auch die Beurteilung eines kapselüberschreitenden Wachstums. Die funktionellen MRT-Methoden wie DWI, DCE-MRI und 1H-MRS erhöhen insbesondere die Spezifität und in geringerem Maße auch die Sensitivität der Diagnostik. Gemäß der interdisziplinären S3-Leitlinie wird die MRT der Prostata bei Patienten mit mindestens einmaliger negativer Biopsie zur Detektion des Karzinoms empfohlen. Demnach sollten karzinomsuspekte Areale zusätzlich zur systematischen Biopsie auch gezielt biopsiert werden. Für die Befundübermittlung der suspekten Areale hat sich das Vorgehen entsprechend der PI-RADS-Klassifikation bewährt. Lokalisation und Staging des Prostatakarzinoms gelingen bildgebend mit Hilfe der MRT am genauesten und werden in der S3-Leitlinie insbesondere für Tumoren im klinischen Stadium cT3/4 oder einem Gleason-Score von  8 oder mehr empfohlen. Zusätzlich zu den erwähnten Anwendungen wird die MRT momentan hauptsächlich unter Studienbedingungen ebenfalls für die Rezidivdiagnostik und die aktive Überwachung eingesetzt.

Abstract

For many clinical issues regarding prostate cancer magnetic resonance imaging (MRI) is gaining increasing importance for prostate diagnostics. The high morphological resolution of T2-weighted sequences is unsurpassed compared to other imaging modalities. It enables not only the detection and localization of prostate cancer but also allows the evaluation of extracapsular extensions. Functional MRI methods, such as diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI and proton magnetic resonance spectroscopy (1H-MRS) increase the specificity and to a lesser extent, the sensitivity of diagnostics. In accordance with the interdisciplinary S3 guidelines, prostate MRI is recommended for patients with at least one negative biopsy for cancer detection. According to the guidelines areas suspected of being cancerous should be selectively biopsied in addition to the systematic biopsy. The transmission of findings about the suspected tumor areas according to the structured PI-RADS classification system has proven its worth. The localization and staging of prostate carcinoma is best achieved with the help of MRI and is recommended in the S3 guidelines especially for tumors with a clinical stage cT3/4 or with a Gleason grading system score ≥8. In addition to these applications MRI is mainly used under study conditions for local recurrence or active surveillance.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Franiel, N. Eckardt, M. Waginger und M. Horstmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Institut für Diagnostische und Interventionelle Radiologie II, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    T. Franiel, N. Eckardt & M. Waginger

  2. Klinik für Urologie, Universitätsklinikum Jena, Jena, Deutschland

    M. Horstmann

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  1. T. Franiel
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  2. N. Eckardt
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Correspondence to T. Franiel.

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Franiel, T., Eckardt, N., Waginger, M. et al. Prostatakarzinom. Radiologe 54, 491–508 (2014). https://doi.org/10.1007/s00117-013-2608-0

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