Cirillo Stefano, Petracchini Massimo, D'Urso Leonardo, Dellamonica Patrizia, Illing Rowland, Regge Daniele, Muto Giovanni
Department of Urology, St. Giovanni Bosco Hospital, Turin, Italy.
BJU Int. 2008 Aug;102(4):452-8. doi: 10.1111/j.1464-410X.2008.07633.x. Epub 2008 May 12.
To assess the role of magnetic resonance imaging (MRI) for evaluating changes in the prostate after transrectal high-intensity focused ultrasound (HIFU) for treating prostate cancer, correlating the findings with histology to assess its possible role in predicting the outcome, evaluating residual cancer or local recurrence of disease.
Ten patients with prostate cancer were assessed with MR and MR spectroscopy (MRS) before and at 1, 4 and 12 months after HIFU, assessing the glandular volume and MRI and MRS data after HIFU. These data were correlated with the prostate-specific antigen (PSA) levels at each examination (suspicious for residual cancer if >0.5 ng/mL) and with histological findings of prostate biopsy sampling at 6-8 months (random or targeted at suspicious MR areas).
Variations in volume during the follow-up were not associated with treatment outcome. MRI was suspicious for residual cancer in one patient at 1 month and in another two at 4 months; in all three patients (one with a PSA level of <0.5 ng/mL) targeted biopsies were positive for cancer. MRI was negative in seven patients; in six of these (one with a PSA level of >0.5 ng/mL) random biopsies were negative, and in one the random biopsies were positive for residual cancer. At 4 months there was a statistically significant difference (P = 0.015) between patients responsive to treatment and those with persistent disease, by combining negative MRI with a PSA level of <0.5 ng/mL; MRS data were suitable for analysis only in three patients with partial necrosis.
Our preliminary data support the role of MRI in association with PSA levels as a useful and accurate tool in the follow-up of patients treated with HIFU for prostate cancer. However, considering the economic issue, it should not be used routinely and should be limited to detecting residual cancer (in patients with a PSA level of >0.5 ng/mL) with the main purpose of improving the detection rate of transrectal ultrasonography (TRUS)-guided prostate biopsy. MRS data had no additional value over MRI. Further evaluation is needed to compare the use of contrast media and other techniques (e.g. colour Doppler TRUS) in detecting residual or local recurrent cancer.
评估磁共振成像（MRI）在经直肠高强度聚焦超声（HIFU）治疗前列腺癌后评估前列腺变化中的作用，将结果与组织学相关联，以评估其在预测治疗结果、评估残留癌或疾病局部复发方面的可能作用。
10例前列腺癌患者在HIFU治疗前、治疗后1个月、4个月和12个月接受了磁共振成像（MR）和磁共振波谱（MRS）检查，评估了HIFU治疗后腺体体积以及MRI和MRS数据。这些数据与每次检查时的前列腺特异性抗原（PSA）水平（若>0.5 ng/mL则怀疑有残留癌）以及6 - 8个月时前列腺活检采样的组织学结果（随机或针对可疑MR区域）相关联。
随访期间体积变化与治疗结果无关。1例患者在1个月时MRI怀疑有残留癌，另外2例在4个月时怀疑有残留癌；在这3例患者中（1例PSA水平<0.5 ng/mL），靶向活检发现癌症阳性。7例患者MRI为阴性；其中6例（1例PSA水平>0.5 ng/mL）随机活检为阴性，1例随机活检发现残留癌阳性。在4个月时，通过将MRI阴性与PSA水平<0.5 ng/mL相结合，治疗有反应的患者与疾病持续存在的患者之间存在统计学显著差异（P = 0.015）；MRS数据仅在3例部分坏死的患者中适合分析。
我们的初步数据支持MRI联合PSA水平作为HIFU治疗前列腺癌患者随访中一种有用且准确的工具的作用。然而，考虑到经济问题，不应常规使用，应限于检测残留癌（PSA水平>0.5 ng/mL的患者），主要目的是提高经直肠超声（TRUS）引导下前列腺活检的检出率。MRS数据相对于MRI没有额外价值。需要进一步评估以比较使用造影剂和其他技术（如彩色多普勒TRUS）在检测残留或局部复发性癌症方面的情况。
