Use of biochemical and imaging criteria for selecting patients for prostate biopsy in recurrence risk assessment post-HIFU therapy.

IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY
Tarek Ajami, Adam Williams, Jonathan T Ryan, Nachiketh Soodana Prakash, Archan Khandekar, Keerthana Sureshkumar, Chad R Ritch, Mark L Gonzalgo, Sanoj Punnen, Dipen J Parekh, Bruno Nahar
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引用次数: 0

Abstract

Purpose: Despite the growing adoption of HIFU treatment for localized prostate cancer (PC), standardized criteria for evaluating success and predicting recurrence remain undefined. Herein, we analyze the predictive value of noninvasive tools such as PSA dynamics and MRI to determine recurrence.

Methods: We identified from our HIFU therapy prospective registry patients who developed biopsy-proven recurrence, between 2016 and 2023. Clinically significant recurrence (CS-R) was defined as the presence of GG 2 or greater on control biopsy. Different modalities of PSA kinetics were analyzed and determinants for recurrence were based on either PSA or MRI criteria (PIRADS > 3). Sensitivity, specificity, PPV, and NPV were estimated based on single or combined criteria.

Results: 92 patients were included in the study. A total of 17(18%) patients had CS-R. Those patients presented higher PSA velocity (p < 0.001) and a higher proportion of PSA above nadir + 1 at 12 months (p = 0.001). Static PSA measurement and % of PSA drop were not associated with recurrence. Follow-up based on a combination of PSA parameters (PSA below nadir + 1) and MRI criteria had higher sensitivity (88%) and negative predictive value (96%) in detecting post-treatment recurrence. Limitation of the study included limited number of patients and a relatively short follow up period.

Conclusions: Post-HIFU recurrence surveillance through dynamic PSA monitoring shows better predictive value. Implementing 'for cause' surveillance biopsies guided by dynamic PSA changes along with mpMRI appears to enhance the detection of recurrences without missing a significant number of cases.

在hifu治疗后复发风险评估中使用生化和影像学标准选择前列腺活检患者。
目的:尽管HIFU治疗局限性前列腺癌(PC)的应用越来越多,但评估成功和预测复发的标准化标准仍不明确。在此,我们分析了PSA动力学和MRI等非侵入性工具对确定复发的预测价值。方法:我们从2016年至2023年期间HIFU治疗的前瞻性登记患者中确定活检证实复发的患者。临床显著复发(CS-R)定义为对照活检中GG 2或更高。分析了PSA动力学的不同模式,并根据PSA或MRI标准分析了复发的决定因素(PIRADS >3)。敏感性、特异性、PPV和NPV根据单一或联合标准进行评估。结果:92例患者纳入研究。共有17例(18%)患者发生CS-R。结论:通过动态PSA监测监测hifu术后复发具有较好的预测价值。在动态PSA变化和mpMRI的指导下实施“原因”监测活检似乎可以增强对复发的检测,而不会遗漏大量病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
World Journal of Urology
World Journal of Urology 医学-泌尿学与肾脏学
CiteScore
6.80
自引率
8.80%
发文量
317
审稿时长
4-8 weeks
期刊介绍: The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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