Abstract
Purpose
The purpose of our study was to retrospectively evaluate and categorize temporal changes in MRI appearances of the prostate in patients who underwent focal therapy with MRI follow-up.
Methods
The Institutional Review Board approved this retrospective study and waived the requirement for informed consent. Thirty-seven patients (median age 61; 48–70 years) with low-to-intermediate-risk, clinically organ-confined prostate cancer underwent focal ablation therapy from 2009 to 2014. Two radiologists reviewed post-treatment MRIs (n = 76) and categorized imaging features blinded to the time interval between the focal therapy and the follow-up MRI. Inter-reader agreement was assessed (kappa) and generalized linear regression was used to examine associations between an imaging feature being present/absent and days between ablation and MRI.
Results
Inter-reader agreement on MRI features ranged from fair to substantial. Edema was found present at earlier times after ablation (median 16–25 days compared to MRIs without edema, median 252–514 days), as was rim enhancement of the ablation zone (18–22.5 days vs. 409–593 days), a hypointense rim around the ablation zone on T2-weighted images (53-57.5 days vs. 279–409 days) and the presence of an appreciable ablation cavity (48.5–60 days vs. 613–798 days, all p < 0.05). Enhancement of the ablation zone/scar (553–731 days vs. 61.5–162 days) and the formation of a T2-hypointense scar were found to be present on later MRI scans (514–553 days vs. 29–32 days, one reader).
Conclusions
The MRI appearance of the prostate after focal ablation changes substantially over time. Identification of temporal patterns in the appearance of imaging features should help reduce image interpretation variability and errors when assessing post-therapeutic scans.
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References
Ahmed HU, El-Shater Bosaily A, Brown LC, et al. (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389(10071):815–822. https://doi.org/10.1016/S0140-6736(16)32401-1
Somford DM, Hamoen EH, Fütterer JJ, et al. (2013) The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol 190(5):1728–1734. https://doi.org/10.1016/j.juro.2013.05.021
Klotz L, Vesprini D, Sethukavalan P, et al. (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33(3):272–277. https://doi.org/10.1200/JCO.2014.55.1192
Oppenheimer DC, Weinberg EP, Hollenberg GM, et al. (2016) Multiparametric magnetic resonance imaging of recurrent prostate cancer. J Clin Imaging Sci 6:18. https://doi.org/10.4103/2156-7514.181494
Ahmed HU, Hindley RG, Dickinson L, et al. (2012) Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol 13(6):622–632. https://doi.org/10.1016/S1470-2045(12)70121-3
Valerio M, Cerantola Y, Eggener SE, et al. (2016) New and established technology in focal ablation of the prostate: a systematic review. Eur Urol . https://doi.org/10.1016/j.eururo.2016.08.044
Ahmed HU, Dickinson L, Charman S, et al. (2015) Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol 68(6):927–936. https://doi.org/10.1016/j.eururo.2015.01.030
Barret E, Harvey-Bryan K-A, Sanchez-Salas R, et al. (2014) How to diagnose and treat focal therapy failure and recurrence? Curr Opin Urol 24(3):241–246. https://doi.org/10.1097/MOU.0000000000000052
Bozzini G, Colin P, Nevoux P, et al. (2013) Focal therapy of prostate cancer: energies and procedures. Urol Oncol 31(2):155–167. https://doi.org/10.1016/j.urolonc.2012.05.011
Welch HG, Fisher ES, Gottlieb DJ, et al. (2007) Detection of prostate cancer via biopsy in the medicare-SEER population during the PSA era. J Natl Cancer Inst 99(18):1395–1400. https://doi.org/10.1093/jnci/djm119
Mian BM, Lehr DJ, Moore CK, et al. (2006) Role of prostate biopsy schemes in accurate prediction of Gleason scores. Urology 67(2):379–383. https://doi.org/10.1016/j.urology.2005.08.018
Kirkham APS, Emberton M, Hoh IM, et al. (2008) MR imaging of prostate after treatment with high-intensity focused ultrasound. Radiology 246(3):833–844. https://doi.org/10.1148/radiol.2463062080
Rosenkrantz AB, Scionti SM, Mendrinos S, et al. (2011) Role of MRI in minimally invasive focal ablative therapy for prostate cancer. AJR Am J Roentgenol 197(1):W90–W96. https://doi.org/10.2214/AJR.10.5946
de Visschere PJ, de Meerleer GO, Futterer JJ, et al. (2010) Role of MRI in follow-up after focal therapy for prostate carcinoma. AJR Am J Roentgenol 194(6):1427–1433. https://doi.org/10.2214/AJR.10.4263
Muller BG, van den Bos W, Brausi M, et al. (2015) Follow-up modalities in focal therapy for prostate cancer: results from a Delphi consensus project. World J Urol 33(10):1503–1509. https://doi.org/10.1007/s00345-014-1475-2
Akin O, Riedl CC, Ishill NM, et al. (2010) Interactive dedicated training curriculum improves accuracy in the interpretation of MR imaging of prostate cancer. Eur Radiol 20(4):995–1002. https://doi.org/10.1007/s00330-009-1625-x
Weinreb JC, Barentsz JO, Choyke PL, et al. (2016) PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol 69(1):16–40. https://doi.org/10.1016/j.eururo.2015.08.052
Eggener SE, Yousuf A, Watson S, et al. (2016) Phase II evaluation of magnetic resonance imaging guided focal laser ablation of prostate cancer. J Urol . https://doi.org/10.1016/j.juro.2016.07.074
Wibmer A, Vargas HA, Donahue TF, et al. (2015) Diagnosis of extracapsular extension of prostate cancer on prostate MRI: impact of second-opinion readings by subspecialized genitourinary oncologic radiologists. AJR Am J Roentgenol 205(1):W73–W78. https://doi.org/10.2214/AJR.14.13600
Bomers JGR, Cornel EB, Futterer JJ, et al. (2016) MRI-guided focal laser ablation for prostate cancer followed by radical prostatectomy: correlation of treatment effects with imaging. World J Urol . https://doi.org/10.1007/s00345-016-1924-1
van den Bos W, de Bruin DM, van Randen A, et al. (2016) MRI and contrast-enhanced ultrasound imaging for evaluation of focal irreversible electroporation treatment: results from a phase I-II study in patients undergoing IRE followed by radical prostatectomy. Eur Radiol 26(7):2252–2260. https://doi.org/10.1007/s00330-015-4042-3
Acknowledgements
The authors thank Ada Muellner, MS for editing the manuscript.
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This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
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All authors declare no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The requirement for informed consent was waived by the local IRB for this retrospective study.
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Hötker, A.M., Meier, A., Mazaheri, Y. et al. Temporal changes in MRI appearance of the prostate after focal ablation. Abdom Radiol 44, 272–278 (2019). https://doi.org/10.1007/s00261-018-1715-9
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DOI: https://doi.org/10.1007/s00261-018-1715-9