Zhang Kai, Teoh Jeremy, Laguna Pilar, Dominguez-Escrig Jose, Barret Eric, Ramon-Borja Juan Casanova, Muir Gordon, Bohr Julia, Gomez Paula Pelechano, de Reijke Theo M, Ng Chi-Fai, Leung Chi-Ho, Sanchez-Salas Rafael, de la Rosette Jean
Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China.
S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
BJU Int. 2025 Jul;136(1):120-127. doi: 10.1111/bju.16720. Epub 2025 Apr 4.
To investigate the diagnostic value of magnetic resonance imaging (MRI) for persistent prostate cancer after irreversible electroporation (IRE) therapy.
This is a post hoc analysis from a multicentre randomised trial, in which men with localised low- to intermediate-risk prostate cancer were randomised to receive either focal or extended IRE ablation. All patients underwent repeat MRI scans at 6 and 12 months and transperineal template mapping biopsy (TMB) at 6 months post-IRE. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI were calculated for infield and outfield lesions using 2 × 2 contingency tables with 95% confidence intervals (CIs) for clinically significant prostate cancer and any-grade prostate cancer.
A total of 106 patients were recruited to this study, including 39 patients (37%) with clinically insignificant prostate cancer and 67 patients (63%) with clinically significant prostate cancer (International Society of Urological Pathology grade ≥2). Of these, 101 patients underwent repeat MRI scan and prostate biopsy at 6 months after IRE. The rate of clinically significant prostate cancer detected by TMB infield and outfield was 9.9% (10/101) and 9.9% (10/101), respectively. In the treated area, the sensitivity, specificity, PPV and NPV for MRI to detect clinically significant prostate cancer were 30% (95% CI 6.7%-65%), 91% (95% CI 82%-96%), 27% (95% CI 6.0%-61%) and 92% (95% CI 84%-97%), respectively. In the untreated area, the sensitivity, specificity, PPV and NPV of MRI to detect clinically significant prostate cancer were 20% (95% CI 2.5%-56%), 91% (95% CI 82%-96%), 20% (95% CI 2.5%-56%) and 91% (95% CI 82%-96%), respectively.
Favourable specificity but poor sensitivity was achieved with use of MRI to detect persistent clinically significant prostate cancer after IRE treatment. Repeat TMB should not be deferred, regardless of MRI results.
探讨磁共振成像（MRI）对不可逆电穿孔（IRE）治疗后持续性前列腺癌的诊断价值。
这是一项来自多中心随机试验的事后分析，试验中，将局限性低至中危前列腺癌男性患者随机分为接受局部或扩大IRE消融治疗。所有患者在IRE治疗后6个月和12个月接受重复MRI扫描，并在6个月时接受经会阴模板映射活检（TMB）。使用2×2列联表计算MRI对靶区内和靶区外病变检测临床显著性前列腺癌和任何分级前列腺癌的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并给出95%置信区间（CI）。
本研究共纳入106例患者，其中39例（37%）为临床无显著性前列腺癌患者，67例（63%）为临床显著性前列腺癌患者（国际泌尿病理学会分级≥2级）。其中，101例患者在IRE治疗后6个月接受了重复MRI扫描和前列腺活检。TMB检测靶区内和靶区外临床显著性前列腺癌的发生率分别为9.9%（10/101）和9.9%（10/101）。在治疗区域，MRI检测临床显著性前列腺癌的敏感性、特异性、PPV和NPV分别为30%（95%CI 6.7%-65%）、91%（95%CI 82%-96%）、27%（95%CI 6.0%-61%）和92%（95%CI 84%-97%）。在未治疗区域，MRI检测临床显著性前列腺癌的敏感性、特异性、PPV和NPV分别为20%（95%CI 2.5%-56%）、91%（95%CI 82%-96%）、20%（95%CI 2.5%-56%）和91%（95%CI 82%-96%）。
IRE治疗后，使用MRI检测持续性临床显著性前列腺癌具有良好的特异性，但敏感性较差。无论MRI结果如何，均不应推迟重复TMB检查。
