Modern imaging and image-guided treatments of the prostate gland: MR and ablation for cancer and prostatic artery embolization for benign prostatic hyperplasia

Abstract

Multiparametric MRI (mpMRI) has proven to be an essential tool for diagnosis, post-treatment follow-up, aggressiveness assessment, and active surveillance of prostate cancer. Currently, this imaging technique is part of the daily practice in many oncological centres. This manuscript aims to review the use of mpMRI in the set of prostatic diseases, either malignant or benign: mpMRI to detect and stage prostate cancer is discussed, as well as its use for active surveillance. Image-guided ablation techniques for prostate cancer are also reviewed. The need to establish minimum acceptable technical parameters for prostate mpMRI, standardize reports, uniform terminology for describing imaging findings, and develop assessment categories that differentiate levels of suspicion for clinically significant prostate cancer led to the development of the Prostate Imaging Reporting and Data System that is reviewed. Special focus will also be given on the most up-to-date evidence of prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH). Management of patients with BPH, technical aspects of PAE, expected outcomes and level of evidence are reviewed with the most recent literature. PAE is a challenging technique that requires dedicated anatomical knowledge and comprehensive embolization skills. PAE has been shown to be an effective minimally-invasive treatment option for symptomatic BPH patients, that can be viewed between medical therapy and surgery. PAE may be a good option for symptomatic BPH patients that do not want to be operated and can obviate the need for prostatic surgery in up to 80% of treated patients.

Hiperplasia prostática benigna - uma revisão abrangente sobre epidemiologia, fatores de risco, fisiopatologia, manifestações clínicas, diagnóstico, classificação e estadiamento, tratamento, perspectivas futuras e pesquisa em andamento

“…Destas, destacam-se a Embolização Arterial Prostática (PAE), na qual as artérias prostáticas são cateterizadas com microcateteres guiados por raios X para redução do tamanho prostático, e a Terapia de Ablação por Laser, que utiliza um feixe de laser inserido transuretralmente para induzir necrose coagulativa na área alvo. Por fim, na termoterapia com micro-ondas, um cateter de tratamento é inserido através da uretra sob orientação ultrassonográfica, fornecendo radiofrequência que produz radiação eletromagnética, resultando na necrose do tecido prostático por calor gerado pelas micro-ondas (João Lopes Dias;Tiago Bilhim, 2019, Jae Hung Jung et al, 2022, Sciacqua et al, 2023Tesolin;Jae Hung Jung, 2023).…”

“…Perspectivas futuras para o tratamento da HPB incluem o desenvolvimento de terapias mais direcionadas e menos invasivas, como a terapia com laser e embolização prostática. Além disso, a pesquisa em andamento está explorando novos alvos moleculares e abordagens terapêuticas para melhorar os resultados e reduzir os efeitos colaterais do tratamento da HPB (João Lopes Dias;Tiago Bilhim, 2019, Liedtke et al, 2024.…”

A kősebészet és a húgyúti endoszkópia hazai és nemzetközi kutatási irányzatai • National and International Research Trends in Stone Surgery and Urinary Tract Endoscopy

“…A húgycsövön keresztül végzett prosztataműtétek (TURP) terén az évtizedek óta alkalmazott hagyományos magasfrekvenciás vágóárammal történő kezelés mellett új módszereket fejlesztenek ki (Tokarski et al, 2021;Dias-Bilhim, 2019).…”

Prostatic Artery Embolization for Benign Prostatic Hyperplasia—A Primer for Interventional Radiologists

“…3 Prostate volume measurement and zonal anatomy of the prostate could be done with transrectal ultrasound or mpMR of the prostate. 4 mpMR has advantages over ultrasound, as it allows for confident identification of prostate cancer, better zonal volumetry and estimation of the intravesical prostatic protrusion, detailed study of the bladder wall, and lumen and can also be used for vascular assessment of the pelvic arteries. However, mpMR is more expensive, time consuming, and less available than prostatic ultrasound.…”

“…As such, mpMR of the prostate can be used at baseline, whereas transrectal ultrasound can be used after PAE to assess prostate volume. 4 Another aspect relevant for PAE planning relies on the vascular mapping of the pelvic and prostatic arteries. One approach has been using computed tomography angiography (CTA) prior to PAE to study the anatomy of the pelvic and prostatic arteries.…”