Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound

Ghafoor, Soleen; Becker, Anton S.; Stocker, Daniel; Barth, Borna K.; Eberli, Daniel; Donati, Olivio F.; Vargas, Hebert Alberto

doi:10.1007/s00261-020-02577-5

Cited by 17 publications

(6 citation statements)

References 69 publications

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“…There is no validated MRI scoring system for post-TULSA progression. The PI-RADS classification is only designed for the assessment of non-treated prostate tissue [23, 31]. According to studies, false-positive DWI findings can occur after HIFU, triggered by the fibrosis that develops after therapy.…”

Section: Discussionmentioning

confidence: 99%

MR-Guided Transurethral Ultrasound Ablation of Prostate Cancer: Initial Experience of Monitoring Tumor Response by Dynamic Apparent Diffusion Coefficient Measurements at 3.0 T

Meyer¹,

Bohlscheid²,

Lemmer³

et al. 2023

Urol Int

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Introduction: Diffusion-weighted imaging (DWI) as part of multiparametric magnetic resonance imaging (mpMRI) is an important sequence for the detection of prostate cancer (PCa). The objective of this retrospective analysis was to evaluate changes in apparent diffusion coefficient (ADC) measurements in biopsy-proven PCa undergoing TULSA-PRO (MR-guided transurethral ultrasound ablation of the prostate) at 3.0 T after 1, 3, and 6–12 months posttreatment. Methods: Nineteen patients underwent follow-up examinations after 1, 3, and 6–12 months including mpMRI at 3.0 T and urological-clinical examinations with quantitative analysis of ADCs. Results: In PCa, a significant increase of ADC values after 6–12 months was measured after TULSA-PRO treatment by 29.1% (pre-TULSA: 0.79 ± 0.16 × 10−3 mm2/s, 6–12 months: 1.02 ± 0.35 × 10−3 mm2/s), while the corresponding value in the reference tissue decreased by 48.5% (pre-TULSA: 1.20 ± 0.15 × 10−3 mm2/s, 6–12 months: 0.91 ± 0.29 × 10−3 mm2/s). The mean ADC values in the early follow-up groups at 1 and 3 months did not change significantly. Conclusion: DWI with ADC as part of mpMRI can serve as a biomarker to dynamically monitor the follow-up after TULSA after 6–12 months. For early posttreatment progression, it is not suitable due to too many confounding variables.

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Section: Discussionmentioning

confidence: 99%

MR-Guided Transurethral Ultrasound Ablation of Prostate Cancer: Initial Experience of Monitoring Tumor Response by Dynamic Apparent Diffusion Coefficient Measurements at 3.0 T

Meyer¹,

Bohlscheid²,

Lemmer³

et al. 2023

Urol Int

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“…The general challenge in prostate cancer to identify patients for AS also applies for cancer relapse after FT. How can we identify the optimal AS candidates with avoidance of overtreatment but without compromising the window for cure in this scenario? A further difficulty is that PI-RADS v2.1 scoring system is designed for treatment-naïve prostates and no scores for the ablation zone after FT have been widely adopted [14]. Nevertheless, AS protocols integrating mpMRI as a radiological biomarker in the untreated zone and ignoring the number of positive cores might improve AS for patients after FT.…”

Section: Discussionmentioning

confidence: 99%

Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer

et al. 2021

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Purpose Due to the tissue preserving approach of focal therapy (FT), local cancer relapse can occur. Uncertainty exists regarding triggers and outcome of salvage strategies. Methods Patients with biopsy-proven prostate cancer (PCa) after FT for localized PCa from 2011 to 2020 at eight tertiary referral hospitals in Germany that underwent salvage radical prostatectomy (S-RP), salvage radiotherapy (S-RT) or active surveillance (AS) were reported. Prostate specific antigen (PSA) changes, suspicious lesions on mpMRI and histopathological findings on biopsy were analyzed. A multivariable regression model was created for adverse pathological findings (APF) at S-RP specimen. Kaplan–Meier curves were generated to determine oncological outcomes. Results A total of 90 men were included. Cancer relapse after FT was detected at a median of 12 months (IQR 9–16). Of 50 men initially under AS 13 received S-RP or S-RT. In total, 44 men underwent S-RP and 13 S-RT. At cancer relapse 17 men (38.6%) in the S-RP group [S-RT n = 4 (30.8%); AS n = 3 (6%)] had ISUP > 2. APF (pT ≥ 3, ISUP ≥ 3, pN + or R1) were observed in 23 men (52.3%). A higher ISUP on biopsy was associated with APF [p = 0.006 (HR 2.32, 97.5% CI 1.35–4.59)] on univariable analysis. Progression-free survival was 80.4% after S-RP and 100% after S-RT at 3 years. Secondary therapy-free survival was 41.7% at 3 years in men undergoing AS. Metastasis-free survival was 80% at 5 years for the whole cohort. Conclusion With early detection of cancer relapse after FT S-RP and S-RT provide sufficient oncologic control at short to intermediate follow-up. After AS, a high secondary-therapy rate was observed.

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“…Recurrences are best detected using functional sequences and are often characterized by early enhancement in the treated lesion, hypointense T2W lesions, restricted diffusion, and hyperintense signal on high b-value on diffusion-weighted imaging (DWI) [3 ▪▪ ,17 ▪ ,18,21]. DCE is an important sequence for several types of ablation and is sensitive for revealing recurrence after HIFU and cryotherapy, along with showing early enhancement with progression after focal laser ablation (FLA) [17 ▪ ].…”

Section: Methods Of Assessment: Imaging In Post-focal Therapy Surveil...mentioning

confidence: 99%

Assessment after focal therapy: what is the latest?

Kotamarti

Séguier

Arcot

et al. 2022

Current Opinion in Urology

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Purpose of reviewTo review assessment after focal therapy (FT) in the context of developments from the past two years.Recent findingsWith a paucity of high-quality studies, recent findings are primarily reliant on results from institutional-based cohorts and reports of expert consensus. Notably, oncologic treatment failure should be further stratified into recurrence in the in-field or out-of-field ablation zone, and both regions should be surveilled postoperatively. Monitoring primarily consists of periodic evaluations of prostate-specific antigen (PSA) testing and magnetic resonance imaging, with histologic sampling needed to confirm suspicion of recurrence. Recent investigations into PSA derivatives, contrast-enhanced ultrasound, and prostate-specific membrane antigen imaging have shown preliminary promise. Although postablation functional outcomes are generally accepted to be excellent, they are limited by the wide range of patient-reported measures, variability in individual practice, and low questionnaire completion rates.SummaryThere is still a need for high-level, long-term data to inform exact standardized protocols to manage patients after FT. A multifaceted approach is required to surveil patients and identify those at risk of recurrence. Embracing shared responsibility between the patient and clinician to fastidiously monitor the infield and out-of-field ablation zones postoperatively is critical to maximize oncologic outcomes.

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Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound

Cited by 17 publications

References 69 publications

MR-Guided Transurethral Ultrasound Ablation of Prostate Cancer: Initial Experience of Monitoring Tumor Response by Dynamic Apparent Diffusion Coefficient Measurements at 3.0 T

MR-Guided Transurethral Ultrasound Ablation of Prostate Cancer: Initial Experience of Monitoring Tumor Response by Dynamic Apparent Diffusion Coefficient Measurements at 3.0 T

Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer

Assessment after focal therapy: what is the latest?

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