Place de l’imagerie IRM, des biopsies en fusion d’image et des nouveaux marqueurs dans la stratégie diagnostique des cancers de la prostate

Abstract

Multiparametric MRI prostate (mp-MRI) is a powerful tool to locate lesions>0.5cm3 (below this threshold tumor volume, prostate cancers are classified as "insignificant"). The detection rate of the mp-MRI for significant cancers of small volume (0.5-1cm3) with a Gleason score≥7is>85%. The prostate mp-MRI optimizes the management of cancers classified as low risk of progression by providing aggressive criteria for misclassified lesions, which require an active treatment and enhance the clinicopathological criteria of indolence for subclinical lesions, which can justify of surveillance. MRI-mp coupled to the 3D ultrasound image fusion, optimizes the predictive value of biopsies and improves tumor staging, particularly when benign prostatic hyperplasia (>40cm3) is associated with clinical course. New tissue markers feasible on biopsies allow to define better the risk of progression of the small volume of cancer in order to reinforce the indications of surveillance or delayed curative treatment.