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. 2022 Nov;40(11):489.e9-489.e17.
doi: 10.1016/j.urolonc.2022.07.017. Epub 2022 Sep 2.

Evaluation of post-ablation mpMRI as a predictor of residual prostate cancer after focal high intensity focused ultrasound (HIFU) ablation

Yash S Khandwala  1 , Shravan Morisetty  1 , Pejman Ghanouni  2 , Richard E Fan  3 , Simon John Christoph Soerensen  1 , Mirabela Rusu  2 , Geoffrey A Sonn  4
Affiliations

Evaluation of post-ablation mpMRI as a predictor of residual prostate cancer after focal high intensity focused ultrasound (HIFU) ablation

Yash S Khandwala et al. Urol Oncol. 2022 Nov.

Abstract

Purpose: To evaluate the performance of multiparametric magnetic resonance imaging (mpMRI) and PSA testing in follow-up after high intensity focused ultrasound (HIFU) focal therapy for localized prostate cancer.

Methods: A total of 73 men with localized prostate cancer were prospectively enrolled and underwent focal HIFU followed by per-protocol PSA and mpMRI with systematic plus targeted biopsies at 12 months after treatment. We evaluated the association between post-treatment mpMRI and PSA with disease persistence on the post-ablation biopsy. We also assessed post-treatment functional and oncological outcomes.

Results: Median age was 69 years (Interquartile Range (IQR): 66-74) and median PSA was 6.9 ng/dL (IQR: 5.3-9.9). Of 19 men with persistent GG ≥ 2 disease, 58% (11 men) had no visible lesions on MRI. In the 14 men with PIRADS 4 or 5 lesions, 7 (50%) had either no cancer or GG 1 cancer at biopsy. Men with false negative mpMRI findings had higher PSA density (0.16 vs. 0.07 ng/mL2, P = 0.01). No change occurred in the mean Sexual Health Inventory for Men (SHIM) survey scores (17.0 at baseline vs. 17.7 post-treatment, P = 0.75) or International Prostate Symptom Score (IPSS) (8.1 at baseline vs. 7.7 at 24 months, P = 0.81) after treatment.

Conclusions: Persistent GG ≥ 2 cancer may occur after focal HIFU. mpMRI alone without confirmatory biopsy may be insufficient to rule out residual cancer, especially in patients with higher PSA density. Our study also validates previously published studies demonstrating preservation of urinary and sexual function after HIFU treatment.

Keywords: Focal therapy; High intensity focused ultrasound; Magnetic resonance imaging; Prostate cancer.

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Conflict of interest statement

Conflict of interests No relevant financial disclosures or conflict of interests. There is no applicable funding for this study.

Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram of patients included in the final analysis.
Fig. 2.
Fig. 2.
Box and Whisker Plots of the Distribution of SHIM and IPSS Scores at Baseline, 3 Months, 12 Months, and 24 months.
Fig. 3.
Fig. 3.
Distribution of PSA Dynamics over Time.
See this image and copyright information in PMC

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