nach oben

Current Urology Reports

Erschienen in:

01.07.2017 | Prostate Cancer (S Prasad, Section Editor)

The Contemporary Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Prostate Cancer

verfasst von: Ariel A. Schulman, Christina Sze, Efrat Tsivian, Rajan T. Gupta, Judd W. Moul, Thomas J. Polascik

Erschienen in: Current Urology Reports | Ausgabe 7/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Growing research supports the use of multiparametric magnetic resonance imaging (mpMRI) for the evaluation of localized prostate cancer (PCa). We highlight contemporary evidence supporting its use in active surveillance (AS).

Recent Findings

The emerging approach to localized PCa favors risk-adapted screening, image-guided biopsies, and selective therapeutic interventions. mpMRI is increasingly critical to achieve each of these aims. Early evidence suggests a value of mpMRI before initial biopsy to guide fusion targeting and to rule out non-organ confined disease as well as in the initiation and serial monitoring of men on AS. There remain concerns regarding understaging cancer with mpMRI and the standardization of expertise beyond the most experienced centers.

Summary

mpMRI is emerging as a critical decision point for staging localized PCa and guiding AS strategies. While there is increasing enthusiasm, the optimal clinical scenario and sequencing remains to be defined.

Vickers AJ, Eastham JA, Scardino PT, Lilja H. The Memorial Sloan Kettering Cancer Center recommendations for prostate cancer screening. Urology. 2016;91:12–8.CrossRefPubMedPubMedCentral

•• Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375(15):1415–24. This landmark prospective, randomized study showed equivalent prostate cancer-specific mortality at 10 years for men on active monitoring compared to interventional treatment, though higher rates of disease progression and metastases were noted in the monitoring group. CrossRefPubMed

• Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015;313(4):390–7. Prospective study of 1003 men with clinical suspicion of prostate cancer showing that MR-targeted biopsies increased detection of high-risk cancer and decreased detection of low-risk cancer. CrossRefPubMedPubMedCentral

Schulman AA, Tay KJ, Robertson CN, Polascik TJ. High-intensity focused ultrasound for focal therapy: reality or pitfall? Curr Opin Urol. 2017;27(2):138–48.CrossRefPubMed

Tay KJ, Villers A, Polascik TJ. Targeted anterior gland focal therapy-a novel treatment option for a better defined disease. Curr Urol Rep 2016;17(10):69-016-0628-9.

•• Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815–22. This multicenter, blinded study of 576 biopsy-naïve men showed that mpMRI was significantly more sensitive than TRUS biopsy (93 vs. 48%, p < 0.0001) for detecting CSC. The negative predictive value of a non-suspicious mpMRI was 89% for excluding CSC. The authors suggested mpMRI be used as a triage to select men for biopsy. CrossRefPubMed

Felker ER, Margolis DJ, Nassiri N, Marks LS. Prostate cancer risk stratification with magnetic resonance imaging. Urol Oncol. 2016;34(7):311–9.CrossRefPubMed

Tay KJ, Gupta RT, Brown AF, Silverman RK, Polascik TJ. Defining the incremental utility of prostate multiparametric magnetic resonance imaging at standard and specialized read in predicting extracapsular extension of prostate cancer. Eur Urol. 2016;70(2):211–3.CrossRefPubMed

Radtke JP, Kuru TH, Bonekamp D, Freitag MT, Wolf MB, Alt CD, et al. Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance. Prostate Cancer Prostatic Dis. 2016;19(3):283–91.CrossRefPubMed

10.

Nassiri N, Margolis DJ, Natarajan S, Sharma DS, Huang J, Dorey FJ, et al. Targeted biopsy to detect Gleason score upgrading during active surveillance for men with low versus intermediate risk prostate cancer. J Urol. 2017;197(3 Pt 1):632–9.CrossRefPubMed

11.

Ahmed HU, Dickinson L, Charman S, Weir S, McCartan N, Hindley RG, et al. Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol. 2015;68(6):927–36.CrossRefPubMed

12.

Harvey H, Orton MR, Morgan VA, Parker C, Dearnaley D, Fisher C, et al. Volumetry of the dominant intraprostatic tumour lesion: intersequence and interobserver differences on multiparametric MRI. Br J Radiol. 2017;90(1071):20160416.CrossRefPubMed

13.

Bianchi R, Cozzi G, Petralia G, Alessi S, Renne G, Bottero D, et al. Multiparametric magnetic resonance imaging and frozen-section analysis efficiently predict upgrading, upstaging, and extraprostatic extension in patients undergoing nerve-sparing robotic-assisted radical prostatectomy. Medicine (Baltimore). 2016;95(40):e4519.CrossRef

14.

Klotz L. Active surveillance for low-risk prostate cancer. Curr Urol Rep 2015;16(4):24-015-0492-z.

15.

Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3):272–7.CrossRefPubMed

16.

Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol. 2015;33(30):3379–85.CrossRefPubMedPubMedCentral

17.

Mohler J, Antonorakis E, Armstrong A, et al. NCCN Clinical Practice Guideline in Oncology. Prostate Cancer. Version 2.2017. 2017; Available at: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed February, 2017, 2017.

18.

Social Security Actuarial Life Table. 2016; Available at: https://www.ssa.gov/OACT/STATS/table4c6.html. Accessed March, 13th, 2017.

19.

Musunuru HB, Yamamoto T, Klotz L, Ghanem G, Mamedov A, Sethukavalan P, et al. Active surveillance for intermediate risk prostate cancer: survival outcomes in the Sunnybrook experience. J Urol. 2016;196(6):1651–8.CrossRefPubMed

20.

Weiner AB, Patel SG, Eggener SE. Pathologic outcomes for low-risk prostate cancer after delayed radical prostatectomy in the United States. Urol Oncol. 2015;33(4):164.e11–7.CrossRef

21.

• Luckenbaugh AN, Auffenberg GB, Hawken SR, Dhir A, Linsell S, Kaul S, et al. Variation in guideline concordant active surveillance follow-up in diverse urology practices. J Urol. 2017;197(3 Pt 1):621–6. Recent study showing that there is a wide variation in follow-up of men on active surveillance. CrossRefPubMed

22.

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64(6):876–92.CrossRefPubMed

23.

Ehdaie B, Vertosick E, Spaliviero M, Giallo-Uvino A, Taur Y, O'Sullivan M, et al. The impact of repeat biopsies on infectious complications in men with prostate cancer on active surveillance. J Urol. 2014;191(3):660–4.CrossRefPubMed

24.

• Oberlin DT, Casalino DD, Miller FH, Meeks JJ. Dramatic increase in the utilization of multiparametric magnetic resonance imaging for detection and management of prostate cancer. Abdom Radiol (NY). 2017;42(4):1255–8. Utilization review showing significant interest in the use of mpMRI in recent years. CrossRef

25.

Muthigi A, Sidana A, George AK, Kongnyuy M, Maruf M, Valayil S, et al. Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance-targeted biopsy. Urol Oncol. 2017;35(1):32.e1–7.CrossRef

26.

Schiffmann J, Wenzel P, Salomon G, Budaus L, Schlomm T, Minner S, et al. Heterogeneity in D’Amico classification-based low-risk prostate cancer: differences in upgrading and upstaging according to active surveillance eligibility. Urol Oncol. 2015;33(7):329.e13–9.CrossRef

27.

Kongnyuy M, Sidana A, George AK, Muthigi A, Iyer A, Fascelli M, et al. The significance of anterior prostate lesions on multiparametric magnetic resonance imaging in African-American men. Urol Oncol. 2016;34(6):254.e15–21.CrossRef

28.

Pessoa RR, Viana PC, Mattedi RL, Guglielmetti GB, Cordeiro MD, Coelho RF, et al. Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance. BJU Int 2016 Aug 8.

29.

Walton Diaz A, Shakir NA, George AK, Rais-Bahrami S, Turkbey B, Rothwax JT, et al. Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance. Urol Oncol. 2015;33(5):202.e1–7.CrossRef

30.

Nassiri N, Natarajan S, Margolis DJ, Marks LS. Targeted prostate biopsy: lessons learned midst the evolution of a disruptive technology. Urology. 2015;86(3):432–8.CrossRefPubMedPubMedCentral

31.

Verma S, Rosenkrantz AB, Choyke P, Eberhardt SC, Eggener SE, Gaitonde K, et al. Commentary regarding a recent collaborative consensus statement addressing prostate MRI and MRI-targeted biopsy in patients with a prior negative prostate biopsy. Abdom Radiol (NY) 2016 Sep 26.

32.

•• Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol. 2016;69(1):16–40. PI-RADS 2.0 is the most widely accepted system for scoring and reporting prostate mpMRI. Increased scores reflect a higher likelihood of clinically significant cancer. CrossRefPubMed

33.

Greer MD, Brown AM, Shih JH, Summers RM, Marko J, Law YM, et al. Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: a multireader study. J Magn Reson Imaging 2016 Jul 8.

34.

Rosenkrantz AB, Pujara AC, Taneja SS. Use of a quality improvement initiative to achieve consistent reporting of level of suspicion for tumor on multiparametric prostate MRI. AJR Am J Roentgenol. 2016;206(5):1040–4.CrossRefPubMed

35.

Rastinehad AR, Abboud SF, George AK, Frye TP, Ho R, Chelluri R, et al. Reproducibility of Multiparametric magnetic resonance imaging and fusion guided prostate biopsy: multi-institutional external validation by a propensity score matched cohort. J Urol. 2016;195(6):1737–43.CrossRefPubMed

36.

Gupta RT, Spilseth B, Froemming AT. How and why a generation of radiologists must be trained to accurately interpret prostate mpMRI. Abdom Radiol (NY) 2016;41(5):803–804.

37.

Garcia-Reyes K, Passoni NM, Palmeri ML, Kauffman CR, Choudhury KR, Polascik TJ, et al. Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis. Abdom Imaging. 2015;40(1):134–42.CrossRefPubMedPubMedCentral

38.

Rosenkrantz AB, Ayoola A, Hoffman D, Khasgiwala A, Prabhu V, Smereka P, et al. The learning curve in prostate MRI interpretation: self-directed learning versus continual reader feedback. AJR Am J Roentgenol. 2016;27:W1–9.

39.

Frye TP, George AK, Kilchevsky A, Maruf M, Siddiqui MM, Kongnyuy M, et al. Magnetic resonance imaging-transrectal ultrasound guided fusion biopsy to detect progression in patients with existing lesions on active surveillance for low and intermediate risk prostate cancer. J Urol 2016 Sep 6.

40.

Oberlin DT, Casalino DD, Miller FH, Matulewicz RS, Perry KT, Nadler RB, et al. Diagnostic value of guided biopsies: fusion and cognitive-registration magnetic resonance imaging versus conventional ultrasound biopsy of the prostate. Urology. 2016;92:75–9.CrossRefPubMedPubMedCentral

41.

Lee DJ, Recabal P, Sjoberg DD, Thong A, Lee JK, Eastham JA, et al. Comparative effectiveness of targeted prostate biopsy using magnetic resonance imaging ultrasound fusion software and visual targeting: a prospective study. J Urol. 2016;196(3):697–702.CrossRefPubMedPubMedCentral

42.

Somford DM, Hamoen EH, Futterer JJ, van Basten JP, Hulsbergen-van de Kaa CA, Vreuls W, et al. The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol. 2013;190(5):1728–34.CrossRefPubMed

43.

Abdi H, Pourmalek F, Zargar H, Walshe T, Harris AC, Chang SD, et al. Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer. Urology. 2015;85(2):423–8.CrossRefPubMed

44.

Murphy IG, NiMhurchu E, Gibney RG, McMahon CJ. MRI-directed cognitive fusion-guided biopsy of the anterior prostate tumors. Diagn Interv Radiol 2017 Jan 11.

45.

Cash H, Gunzel K, Maxeiner A, Stephan C, Fischer T, Durmus T, et al. Prostate cancer detection on transrectal ultrasonography-guided random biopsy despite negative real-time magnetic resonance imaging/ultrasonography fusion-guided targeted biopsy: reasons for targeted biopsy failure. BJU Int. 2016;118(1):35–43.CrossRefPubMed

46.

Tay KJ, Gupta RT, Rastinehad AR, Tsivian E, Freedland SJ, Moul JW, et al. Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls. Expert Rev Anticancer Ther. 2016;16(3):303–11.CrossRefPubMed

47.

Gupta RT, Brown AF, Silverman RK, Tay KJ, Madden JF, George DJ, et al. Can radiologic staging with multiparametric MRI enhance the accuracy of the Partin tables in predicting organ-confined prostate cancer? AJR Am J Roentgenol. 2016;207(1):87–95.CrossRefPubMed

48.

Bratan F, Melodelima C, Souchon R, Hoang Dinh A, Mege-Lechevallier F, Crouzet S, et al. How accurate is multiparametric MR imaging in evaluation of prostate cancer volume? Radiology. 2015;275(1):144–54.CrossRefPubMed

49.

• Radtke JP, Boxler S, Kuru TH, Wolf MB, Alt CD, Popeneciu IV, et al. Improved detection of anterior fibromuscular stroma and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance. Prostate Cancer Prostatic Dis. 2015;18(3):288–96. This study highlights the benefit of mpMRI in detecting anterior gland lesions that may be missed by TRUS biopsy. CrossRefPubMed

50.

Henderson DR, de Souza NM, Thomas K, Riches SF, Morgan VA, Sohaib SA, et al. Nine-year follow-up for a study of diffusion-weighted magnetic resonance imaging in a prospective prostate cancer active surveillance cohort. Eur Urol. 2016;69(6):1028–33.CrossRefPubMed

51.

Schoots IG, Petrides N, Giganti F, Bokhorst LP, Rannikko A, Klotz L, et al. Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol. 2015;67(4):627–36. CrossRefPubMed

52.

• Kongnyuy M, Sidana A, George AK, Muthigi A, Iyer A, Ho R, et al. Tumor contact with prostate capsule on magnetic resonance imaging: a potential biomarker for staging and prognosis. Urol Oncol. 2017;35(1):30.e1–8. The authors quantify the significance of tumor contact with the capsule seen on mpMRI and its association with pathologic findings and biochemical recurrence. CrossRef

53.

Ma TM, Tosoian JJ, Schaeffer EM, Landis P, Wolf S, Macura KJ, et al. The role of multiparametric magnetic resonance imaging/ultrasound fusion biopsy in active surveillance. Eur Urol. 2017;71(2):174–80.CrossRefPubMed

54.

Meng X, Rosenkrantz AB, Mendhiratta N, Fenstermaker M, Huang R, Wysock JS, et al. Relationship between prebiopsy multiparametric magnetic resonance imaging (MRI), biopsy indication, and MRI-ultrasound fusion-targeted prostate biopsy outcomes. Eur Urol. 2016;69(3):512–7.CrossRefPubMed

55.

Alberts AR, Schoots IG, Bokhorst LP, van Leenders GJ, Bangma CH, Roobol MJ. Risk-based patient selection for magnetic resonance imaging-targeted prostate biopsy after negative transrectal ultrasound-guided random biopsy avoids unnecessary magnetic resonance imaging scans. Eur Urol. 2016;69(6):1129–34.CrossRefPubMed

56.

Mendhiratta N, Meng X, Rosenkrantz AB, Wysock JS, Fenstermaker M, Huang R, et al. Prebiopsy MRI and MRI-ultrasound fusion-targeted prostate biopsy in men with previous negative biopsies: impact on repeat biopsy strategies. Urology. 2015;86(6):1192–8.CrossRefPubMedPubMedCentral

57.

Tran GN, Leapman MS, Nguyen HG, Cowan JE, Shinohara K, Westphalen AC, et al. Magnetic resonance imaging-ultrasound fusion biopsy during prostate cancer active surveillance. Eur Urol 2016 Aug 29.

58.

Recabal P, Assel M, Sjoberg DD, Lee D, Laudone VP, Touijer K, et al. The efficacy of multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy in risk classification for patients with prostate cancer on active surveillance. J Urol. 2016;196(2):374–81.CrossRefPubMed

59.

Dall’Era MA, Klotz L. Active surveillance for intermediate-risk prostate cancer. Prostate Cancer Prostatic Dis. 2017;20(1):1–6.CrossRefPubMed

60.

Gondo T, Hricak H, Sala E, Zheng J, Moskowitz CS, Bernstein M, et al. Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer. Eur Radiol. 2014;24(12):3161–70.CrossRefPubMed

61.

Truong M, Hollenberg G, Weinberg E, Messing EM, Miyamoto H, Frye TP. Impact of Gleason subtype on prostate cancer detection using multiparametric MRI: correlation with final histopathology. J Urol 2017 2.

62.

Le Nobin J, Rosenkrantz AB, Villers A, Orczyk C, Deng FM, Melamed J, et al. Image guided focal therapy for magnetic resonance imaging visible prostate cancer: defining a 3-dimensional treatment margin based on magnetic resonance imaging histology co-registration analysis. J Urol. 2015;194(2):364–70.CrossRefPubMedPubMedCentral

63.

Futterer JJ, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A, et al. Can clinically significant prostate cancer be detected with Multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol. 2015;68(6):1045–53.CrossRefPubMed

64.

• Priester A, Natarajan S, Khoshnoodi P, Margolis DJ, Raman SS, Reiter RE, et al. Magnetic resonance imaging underestimation of prostate cancer geometry: use of patient specific molds to correlate images with whole mount pathology. J Urol. 2017;197(2):320–6. Detailed study correlating mpMRI findings with whole-mount pathology specimens that highlights important potential limitations in tumor length and volume estimates by mpMRI. It is worth the potential margin of error when translating mpMRI results to clinical decision-making. CrossRefPubMed

65.

Tonttila PP, Lantto J, Paakko E, Piippo U, Kauppila S, Lammentausta E, et al. Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: results from a randomized prospective blinded controlled trial. Eur Urol. 2016;69(3):419–25.CrossRefPubMed

66.

Shin T, Smyth TB, Ukimura O, Ahmadi N, de Castro Abreu AL, Oishi M, et al. Detection of prostate cancer using magnetic resonance imaging/ultrasonography image-fusion targeted biopsy in African-American men. BJU Int. 2017 Jan 23.

67.

Crawford ED, Albala DM, Wysocki JS, Lepor H, Ross AE, Finkelstein SE, et al. Prostate Cancer Academy 2016: presentation summaries. Rev Urol. 2016;18(4):205–13.PubMedPubMedCentral

68.

Yin Y, Zhang Q, Zhang H, He Y, Huang J. Molecular signature to risk-stratify prostate cancer of intermediate risk. Clin Cancer Res. 2017;23(1):6–8.CrossRefPubMed

69.

• van Leeuwen PJ, Hayen A, Thompson JE, Moses D, Shnier R, Bohm M, et al. A multiparametric magnetic resonance imaging based risk model to determine the risk of significant prostate cancer prior to biopsy. BJU Int 2017 Feb 16. This paper presents a risk model to determine the presence of significant cancer on biopsy that incorporates both mpMRI findings and clinical parameters. These models will likely become more refined in the future and increasing mpMRI data becomes available.

Titel: The Contemporary Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Prostate Cancer
verfasst von: Ariel A. Schulman
Christina Sze
Efrat Tsivian
Rajan T. Gupta
Judd W. Moul
Thomas J. Polascik
Publikationsdatum: 01.07.2017
Verlag: Springer US
Erschienen in: Current Urology Reports / Ausgabe 7/2017
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-017-0699-2

Neu im Fachgebiet Urologie

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

Stufenschema weist Prostatakarzinom zuverlässig nach

22.04.2024 Prostatakarzinom Nachrichten

Erst PSA-Test, dann Kallikrein-Score, schließlich MRT und Biopsie – ein vierstufiges Screening-Schema kann die Zahl der unnötigen Prostatabiopsien erheblich reduzieren: Die Hälfte der Männer, die in einer finnischen Studie eine Biopsie benötigten, hatte einen hochgradigen Tumor.

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

20.04.2024 EAU 2024 Kongressbericht

Beim chronischen Harnwegsinfekt bei Frauen wird bisher meist eine Antibiotikaprophylaxe eingesetzt. Angesichts der zunehmenden Antibiotikaresistenz erweist sich das Antiseptikum Methenamin-Hippurat als vielversprechende Alternative, so die Auswertung einer randomisierten kontrollierten Studie.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2017

Prostate Biopsy in Active Surveillance Protocols: Immediate Re-biopsy and Timing of Subsequent Biopsies

Adjuvant Versus Early Salvage Radiation Therapy Following Radical Prostatectomy for Men with Localized Prostate Cancer

Tissue Preservation Techniques at the Time of Urethroplasty for Urethral Stricture Disease

The use of Hormonal Therapy to Augment Radiation Therapy in Prostate Cancer: An Update

Testosterone Therapy on Active Surveillance and Following Definitive Treatment for Prostate Cancer