(精选)【医学英文课件】 Image-Guided Therapy for Prostate Cancer The focal approach教学课件.ppt

Rafael Sanchez-Salas, MD Department of Urology L’Institute Mutualiste Montsouris Paris, France;Disclosures;Agenda;Image-guided Therapy for Prostate Cancer: Quo Vadis?;Image-guided Therapy for Prostate Cancer;Focal Therapy for PCa: Level of Evidence of Current Recommendations for Common Practice;Agenda;Diagnosis of Prostate Cancer and Selection for Focal Therapy;56 patients treated with HIFU–index lesion ablation At 12 mo: - 80.8% patients had histological absence of clinically significant cancer 85.7% had no measurable PCa (biopsy and/or mpMRI) - 3.6% patients had clinically significant disease in untreated areas not detected at baseline ;Agenda;de Rooij M, et al. AJR Am J Roentgenol. 2014 Hambrock, et al. Radiology. 2011;526 patients—The pooled data showed a specificity of 0.88 (95% CI, 0.82–0.92) and sensitivity of 0.74 (95%CI, 0.66–0.81) for prostate cancer detection. ;mpMRI is the optimal approach for focal therapy. High-quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) Judged by an experienced radiologist. mpMRI has sufficient potential to detect a lesion of ~0.5 mL with sensitivity as well as specificity of ~90%.;Imaging in Localized Prostate Cancer: mpUS;Real-time elastography detected prostate cancer with 49% sensitivity and 73.6% specificity. It would suggest that the HS protocol requires further refinement before clinical implementation. The multiparametric approach decreased the false-positive value of real-time elastography alone from 34.9% to 10.3% and improved the positive predictive value of cancer detection from 65.1% to 89.7%.;Imaging in Localized Prostate Cancer: mpUS;Combined PET/MRI may provide adequate tissue contrast and help to enhance the clinical assesment of patients with MRI invisible PCa;Agenda;Prostatic Biopsies: Available Techniques and Approaches;Prostatic Biopsies: Available Techniques and Approaches;Combined FTB and SB detected 97% of all significant PCa (sPCa) lesions and wa