EAU14 Souvenir Session: Urological imaging is a highly evolving field but approaches should change

Imaging in urology is undergoing rapid changes but current research needs to change and should concentrate on well-designed and high quality studies, according to Prof. Peter Albers (DE).

“Imaging is really an evolving field in urology. However, the way we look at it is not really scientific,” said Albers as he noted that there is a need to focus current research work on high quality studies. Albers spoke during the Souvenir Session of the final plenary meeting at the 29th Annual EAU Congress which ended today in Stockholm, Sweden.

He mentioned three main topics in urological imaging, namely, the emergence of new ultrasound techniques to detect prostate cancer (PCa), the use of multiparameter Magnetic Resonance Imaging (mpMRI) in PCa detection and diagnosis, and the use of radionuclide imaging in detecting PSA recurrence following radical prostatectomy and/or radiotherapy.

Regarding MRI use, Albers said the queries to address are the use of MRI for primary detection, for secondary detection after prior negative biopsty or for active surveillance. He noted that the are no clear answers yet considering that studies are ongoing and outcomes have yet to be fully evaluated.

He mentioned the entry of a new tracer such as Gallium-68 for positron emission tomography (PET) imaging, which has significantly improved the quality of imaging, while adding that this needs confirmation in larger series of trials.

In his concluding remarks, Albers said: “New ultrasound techniques like elastography and histoscanning, currently, do not improve the detection of prostate cancer.” And although “mpMRI is useful to detect prostate cancer,” he noted that 31% of tumours, however, are not detected ( including up to 6% of significant tumours) if mpMRI is used alone.

For the first biopsy, TRUS remains the standard with mpMRI facilatating the detection of significant tumours, according to Albers. “For the second biopsy, mpMRI is helpful to detect tumours outside of the usual TRUS templates,” he added.