The biggest change is that the association has revised the role of multiparametric MRI (mpMRI) in the diagnosis of prostate cancer. Key changes include the following:
- Do not use mpMRI as an initial screening tool.
- Adhere to Prostate Imaging Reporting and Data System (PI-RADS) guidelines for mpMRI acquisition and interpretation.
- In patients who have not had a biopsy, when mpMRI is positive (i.e., PI-RADS ≥ 3), combine targeted and systematic biopsy.
- In patients with prior negative biopsy, perform mpMRI before prostate biopsy.
- When mpMRI is negative (i.e., PI-RADS ≤ 2) and clinical suspicion of prostate cancer is high, perform systematic biopsy based on shared decision-making with the patient.
- Use individual life expectancy, health status, and comorbidity to guide prostate cancer management.
- For men in active surveillance, perform mpMRI before a confirmatory prostate biopsy, if it hasn't been done before the first biopsy.
- For external-beam radiation therapy (EBRT), use a total dose of 76 Gy to 78 Gy, or moderate hypofractionation (60 Gy/20 fractions in four weeks or 70 Gy/28 fractions in six weeks), in combination with short-term neoadjuvant plus concomitant androgen deprivation therapy (four to six months).
The guidelines were developed in collaboration with the European Association of Nuclear Medicine (EANM).
Copyright © 2019 AuntMinnieEurope.com