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.
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.