Séguier Denis, Puech Philippe, Barret Eric, Leroy Xavier, Labreuche Julien, Penna Raphael Renard, Ploussard Guillaume, Villers Arnauld, Olivier Jonathan
Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France.
University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France.
Prostate Cancer Prostatic Dis. 2024 Sep 10. doi: 10.1038/s41391-024-00885-1.
Prostate cancer remains the most frequently diagnosed cancer among men. High-Intensity Focused Ultrasound (HIFU) has emerged as a thermal ablative technique for partial-gland-ablation (PGA), aiming to minimize collateral damage while maximizing tumor control. Monitoring after HIFU PGA relies on serial PSA testing, multiparametric-MRI, and biopsies. The diagnostic accuracy of MRI for clinically-significant cancer(csPCa) recurrence is challenging.
This systematic review and meta-analysis aim to evaluate the accuracy of MRI in detecting early recurrence of localized prostate cancer following HIFU PGA.
Adhering to PRISMA guidelines, a comprehensive literature search was conducted until May 8 2024 using MEDLINE and Scopus. The inclusion criteria encompassed randomized controlled trials and cohort studies involving men diagnosed with localized prostate cancer who had as primary treatment HIFU PGA. The primary outcome measures included the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) of MRI for csPCa(ISUP ≥ 2) based on biopsy results. We pooled data from studies with sufficient csPCa and csPCa-free patients (≥5) post HIFU for statistical analysis.
Fifteen studies meet the inclusion criteria, encompassing 1093 patients and 12 studies were eligible for meta-analysis. MRI sensitivity in detecting clinically-significant prostate cancer (csPCa) recurrence post HIFU PGA varied widely (0-89%), with a pooled sensitivity of 0.52 (95% CI:0.36-0.68). Specificity ranged from 44% to 100%, with a pooled specificity of 0.81 (95% CI:0.68-0.91). The pooled NPV was 0.82 (95% CI:0.72-0.90), and the pooled PPV was 0.50 (95% CI:0.35-0.65). Three studies reported in-field diagnostic performance with sensitivities ranging from 0.42 to 0.80 and specificities from 0.45 to 0.97.
MRI accuracy for clinically-significant recurrence after partial gland ablation with HIFU for localized prostate cancer shows low diagnostic performance in the treated lobe with pooled sensitivity of 0.52 (95% CI:0.36-0.68) and specificity of 0.81 (95% CI:0.68-0.91). Limits of this review include the low number of studies reporting about site of recurrence in or out of the treated lobe.
前列腺癌仍然是男性中最常被诊断出的癌症。高强度聚焦超声（HIFU）已成为一种用于部分腺体消融（PGA）的热消融技术，旨在将附带损伤降至最低，同时最大程度地控制肿瘤。HIFU PGA后的监测依赖于连续的前列腺特异性抗原（PSA）检测、多参数MRI和活检。MRI对临床显著癌症（csPCa）复发的诊断准确性具有挑战性。
本系统评价和荟萃分析旨在评估MRI在检测HIFU PGA后局限性前列腺癌早期复发方面的准确性。
遵循PRISMA指南，截至2024年5月8日，使用MEDLINE和Scopus进行了全面的文献检索。纳入标准包括随机对照试验和队列研究，研究对象为被诊断为局限性前列腺癌且将HIFU PGA作为主要治疗方法的男性。主要结局指标包括基于活检结果的MRI对csPCa（国际泌尿病理学会[ISUP]≥2）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。我们汇总了HIFU后有足够数量的csPCa患者和无csPCa患者（≥5）的研究数据进行统计分析。
15项研究符合纳入标准，涵盖1093例患者，12项研究符合荟萃分析的条件。MRI检测HIFU PGA后临床显著前列腺癌（csPCa）复发的敏感性差异很大（0 - 89%），汇总敏感性为0.52（95%置信区间：0.36 - 0.68）。特异性范围为44%至100%，汇总特异性为0.81（95%置信区间：0.68 - 0.91）。汇总的NPV为0.82（95%置信区间：0.72 - 0.90），汇总的PPV为0.50（95%置信区间：0.35 - 0.65）。三项研究报告了视野内的诊断性能，敏感性范围为0.42至0.80，特异性范围为0.45至0.97。
对于局限性前列腺癌采用HIFU进行部分腺体消融后临床显著复发的MRI准确性，在治疗的腺叶中显示出较低的诊断性能，汇总敏感性为0.52（95%置信区间：0.36 - 0.68），特异性为0.81（95%置信区间：0.68 - 0.91）。本综述的局限性包括报告治疗腺叶内或外复发部位的研究数量较少。
