Oncological Outcome and Value of Postoperative Magnetic Resonance Imaging after Focal High-Intensity Focused Ultrasound Therapy for Prostate Cancer

Abstract

<b><i>Introduction:</i></b> Focal therapy (FT) by high-intensity focused ultrasound (HIFU) is an emerging option for localized prostate cancer (PC). Due to the lack of long-term data, a close monitoring after FT is essential, but there are still uncertainties about the optimal follow-up regimen. Here we report on a series of FT-HIFU patients with the focus on oncological short-term outcome and the value of postoperative magnetic resonance imaging (MRI). <b><i>Methods:</i></b> We included 21 patients treated by FT-HIFU using the Focal One® device (EDAP TMS, France) between November 2015 and May 2018. PC localization was assessed by preoperative multiparametric MRI (mpMRI) and transrectal ultrasound-guided targeted and systematic biopsy. Oncological follow-up included prostate-specific antigen (PSA) development, mpMRI, control biopsies (targeted and systematic) of the treated and untreated areas and salvage treatment rate. Control mpMRI and control biopsy were performed after 6–12 months. <b><i>Results:</i></b> 15 patients (71.4%) were managed by focal ablation of a solitary lesion, while 6 patients (28.6%) underwent zonal tumor ablation. All patients underwent control mpMRI and biopsy. After a mean follow-up period of 11.7 months, cancer relapse was detected in 8 patients (38.1%), with 4 patients (19%) having infield recurrence. Postoperative mpMRI revealed 3 out of 4 infield PC relapses but missed 5 out of 7 outfield relapses. Clinically significant cancer recurrence was present in 1 patient (4.8%), which was missed by mpMRI. Posttreatment mpMRI had a sensitivity, specificity, positive and negative predictive value of 62.5, 92.3, 83.3 and 80.0%, respectively, for overall relapse detection based on patient level. Only 1 of the 8 recurrences was suspected based on PSA progression. 4 of the 8 patients with PC relapse (19%) underwent salvage therapy (2 patients by radical prostatectomy, 2 patients by salvage FT-HIFU). <b><i>Conclusion:</i></b> Postoperative mpMRI might play a valuable role during follow-up after focal HIFU therapy, particularly in terms of infield relapse detection. Irrespective of mpMRI results, the repeat biopsy regimen should incorporate systematic biopsy including cores of the treated and untreated prostate areas.

Postoperative Effect Observation and Clinical Study of Dahuang Zhechong Pills from Jingui Yaolue in Treating Patients with Early-to-Mid Prostate Cancer Undergoing Radical Resection

“…The pathogenic mechanism of prostate cancer may be related to race, heredity, environment, food, smoking, sex hormone, etc. The disease is slowly progressive, with no specific manifestations in the early stage, and as the tumor grows gradually, it can invade into the urethra and bladder neck, often complicated by metastasis to bone and other routes and seriously threatening the life of patients [ 3 , 4 ]. Currently, radical prostatectomy is the first choice for treatment, with stable results.…”

Assessment after focal therapy: what is the latest?

“…Similar findings were appreciated at median 49 months (although only 38.9% had late MRI/biopsy), as 63% of cases with hyper-enhancement and 83% with restricted diffusion returned with recurrence [22]. Rosenhammer et al found that MRI at 6 – 12 months after focal HIFU identified three of four IFF but missed five of seven OFF; however, only one missed recurrence (4.8%) was GGG ≥ 2 [23]. The authors reported MRI sensitivity, specificity, PPV, and NPV for relapse detection of 62.5%, 92.3%, 83.3%, and 80.0%, respectively.…”

High-Intensity Focused-Ultrasound Focal Therapy Versus Laparoscopic Radical Prostatectomy: A Comparison of Oncological and Functional Outcomes in Low- and Intermediate-Risk Prostate Cancer Patients

“…Given the lack of clear definition of treatment failure, we believe that the followup of patients after FT should not be based on a single variable and should preferably combine PSA kinetics monitoring with mpMRI and biopsy [20]; however, it is evident that establishing an optimal protocol will require further studies.…”