Kongnyuy Michael, Halpern Daniel M, Liu Corinne C, Kosinski Kaitlin E, Habibian David J, Corcoran Anthony T, Katz Aaron E
Department of Urology, NYU-Winthrop University, 1300 Franklin Ave, Garden City, Mineola, NY, USA.
Department of Radiology, NYU-Winthrop University, Mineola, NY, USA.
Int Urol Nephrol. 2017 Nov;49(11):1947-1954. doi: 10.1007/s11255-017-1670-3. Epub 2017 Aug 10.
We aimed to report on multiparametric MRI (mpMRI) characteristics of post-primary focal cryosurgery (PFC) patients suspected of biochemical recurrence (BCR) by the Phoenix criteria.
We retrospectively reviewed all patients at our institution who had undergone PFC. Prostate-specific antigen nadir was determined using 2 or more post-PFC values. Suspicion of BCR was determined using the Phoenix criteria (nadir + 2 ng/ml). At the discretion of the physician, pre-and post-PFC 3-T mpMRIs were obtained and in a few cases biopsies were performed.
Ninety (58.4%) of 154 consecutive patients who underwent PFC were included in our analysis and had a median (range) age and prostate volume of 66.5 (48-82) years and 40.5 (16-175) ml, respectively. Of those suspected of BCR (37/90, 41.1%), with a median time to BCR of 19.9 (7.0-38.5) months, 27 patients (73.0%) underwent a post-PFC mpMRI. Twenty-two (81.5%) of these mpMRIs were found with 24 suspicious lesions. A considerable number (9/24, 37.5%) of these lesions were located in the central gland of the prostate. Seven of 24 lesions exhibited adverse mpMRI characteristic; 4 (16.7%) had capsular contact, 2 (8.2%) showed frank extracapsular extension, and 1 (4.2%) showed seminal vesicle invasion. Five (45.5%) of 11 patients with positive post-PFC mpMRIs were positive on biopsy (4/5, 80% were clinically significant prostate cancer).
Post-PFC mpMRI, at Phoenix suspicion of BCR, may help identify a significant number of patients failing post-PFC.
我们旨在报告根据凤凰标准怀疑生化复发（BCR）的原发性局灶性冷冻消融术（PFC）后患者的多参数磁共振成像（mpMRI）特征。
我们回顾性分析了本机构所有接受过PFC的患者。使用2个或更多PFC后的数值确定前列腺特异性抗原最低点。根据凤凰标准（最低点 + 2 ng/ml）确定是否怀疑BCR。根据医生的判断，获取PFC前后的3-T mpMRI，少数情况下进行活检。
154例连续接受PFC的患者中有90例（58.4%）纳入我们的分析，中位（范围）年龄和前列腺体积分别为66.5（48 - 82）岁和40.5（16 - 175）ml。在怀疑BCR的患者中（37/90，41.1%），BCR的中位时间为19.9（7.0 - 38.5）个月，27例患者（73.0%）接受了PFC后的mpMRI检查。这些mpMRI中有22例（81.5%）发现了24个可疑病变。这些病变中有相当数量（9/24，37.5%）位于前列腺中央腺体。24个病变中有7个表现出不良的mpMRI特征；4个（16.7%）有包膜接触，2个（8.2%）显示明显的包膜外侵犯，1个（4.2%）显示精囊侵犯。11例PFC后mpMRI阳性的患者中有5例（45.5%）活检阳性（4/5，80%为临床显著前列腺癌）。
在凤凰标准怀疑BCR时，PFC后的mpMRI可能有助于识别大量PFC失败的患者。
