Department of Urology, Stanford University Medical Center, Stanford, CA.
Department of Radiology, Stanford University Medical Center, Stanford, CA.
Urol Oncol. 2022 Nov;40(11):489.e9-489.e17. doi: 10.1016/j.urolonc.2022.07.017. Epub 2022 Sep 2.
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.
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.
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/mL, 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.
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.
评估高强度聚焦超声（HIFU）局灶治疗后，多参数磁共振成像（mpMRI）和 PSA 检测在随访中的表现，用于局限性前列腺癌。
共前瞻性纳入 73 例局限性前列腺癌患者，接受局灶 HIFU 治疗后，按方案在治疗后 12 个月进行 PSA 和 mpMRI 检查（包括系统加靶向活检）。我们评估了治疗后 mpMRI 和 PSA 与消融后活检中疾病持续存在之间的关系。我们还评估了治疗后的功能和肿瘤学结果。
中位年龄为 69 岁（四分位距（IQR）：66-74），中位 PSA 为 6.9ng/dL（IQR：5.3-9.9）。19 例 GG≥2 持续存在的患者中，58%（11 例）在 MRI 上无可见病变。在 14 例 PIRADS 4 或 5 病变的患者中，7 例（50%）在活检时无癌或 GG1 癌。mpMRI 假阴性患者的 PSA 密度更高（0.16 比 0.07ng/mL，P=0.01）。治疗后，男性健康调查（SHIM）问卷评分均值（基线时为 17.0 分，治疗后为 17.7 分，P=0.75）或国际前列腺症状评分（IPSS）（基线时为 8.1 分，24 个月时为 7.7 分，P=0.81）均无变化。
局灶 HIFU 后可能会出现 GG≥2 癌症持续存在。单独进行 mpMRI 检查而不进行确认性活检可能不足以排除残留癌症，尤其是在 PSA 密度较高的患者中。我们的研究还验证了先前发表的研究结果，即 HIFU 治疗后可保留尿和性功能。
