March 2015

MRI guided interventions to help redefine prostate cancer management).

Wednesday, March 4, 2015 (ECR) – Prostate cancer diagnosis and management have to be radically rethought and redefined, speakers will argue in a session on image-guided interventions of the prostate on Friday at ECR 2015. Session chairman Anwar R. Padhani, a consultant radiologist at Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, and Professor of the Institute of Cancer Research, London, explained why ahead of the ECR Opening Press Conference on Wednesday.

“The prostate cancer diagnostic and therapy pathway is controversial. Serum PSA causes false alarms and gives false reassurance, while biopsies, which are systematic but non-targeted miss at least 20– 30% of cancers and underestimate cancer aggressiveness in 20–30% of cases. Our current diagnostic methods are insufficient for distinguishing non-aggressive disease from virulent cancers,” he said.

Under the current pathway, clinically indolent cancers are identified by chance, significant lesions are missed and important cancers are incorrectly classified as unimportant. As a result, men undergo whole-gland treatment for cancers that would not affect their lives, often with consequences that are a significant burden (incontinence, impotence) and costly.

“Men with prostate cancer are under-diagnosed and over-diagnosed, under-treated and overtreated; it’s a mess,” Padhani said. “Men are demanding rapid improvements and imaging is the way forward,” he added.

It is imperative that the killer prostate cancer within the gland is detected, defined and targeted. New ultrasound techniques and multi-parametric MRI used during biopsies now enable us to do that, and radiologists must know how to make the most of these tools.

The session will provide a comprehensive overview of the imaging technologies available for focal prostate gland sampling in patients with suspected malignancy, and a discussion of imaging methods for therapy of malignant and benign diseases of the prostate gland, including long-term results and complications. It will also offer a forum for open discussions on the needs for minimally invasive diagnostic and treatment technologies for the prostate gland.

Padhani hopes the session will inspire radiologists to change their approach to prostate cancer management. “We must change, and for that, we must think differently. Prostate cancer is the last cancer in which imaging is not a key element of the diagnostic pathway. Multi-parametric MRI is becoming a key component of the prostate cancer diagnosis pathway and targeted biopsies of lesions under MRI guidance are likely to become a part of the diagnostic pathway. Tissue preservation, by active surveillance and focal therapy, will reduce the over-treatment burden of localised disease,” he concluded.

Anwar R. Padhani: Consultant radiologist at Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, and professor of the Institute of Cancer Research and honorary senior lecturer at University College, London, United Kingdom


Friday, March 6, 08:30–10:00, Room E2

NH 9 Image-guided interventions of the prostate

  • Chairman’s introduction: defining the target
    A.R. Padhani; London/UK
  • MR-targeted prostate biopsy
    J.J. Fütterer; Nijmegen/NL
  • MR-US fusion prostate biopsy
    F. Cornud; Paris/FR
  • Image-guided tumour ablations
    H.U. Ahmed; London/UK
  • Prostate artery embolisation (PAE) for benign hypertrophy
    F.C. Carnevale; Sao Paulo/BR
  • Panel discussion: Do organ-sparing prostatic treatments make sense?