MRI accuracy for recurrence after partial gland ablation with HIFU for localized prostate cancer. A systematic review and meta-analysis

Denis Séguier; Philippe Puech; Eric Barret; Xavier Leroy; Julien Labreuche; Raphael Renard Penna; Guillaume Ploussard; Arnauld Villers; Jonathan Olivier

doi:10.1038/s41391-024-00885-1

MRI accuracy for recurrence after partial gland ablation with HIFU for localized prostate cancer. A systematic review and meta-analysis

Prostate Cancer Prostatic Dis. 2024 Sep 10. doi: 10.1038/s41391-024-00885-1. Online ahead of print.

Authors

Denis Séguier^{1

2}, Philippe Puech³, Eric Barret⁴, Xavier Leroy^{5

6}, Julien Labreuche⁷, Raphael Renard Penna⁸, Guillaume Ploussard⁹, Arnauld Villers^{10

5}, Jonathan Olivier^{10

5}

Affiliations

¹ Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France. denis.seguier@chu-lille.fr.
² University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France. denis.seguier@chu-lille.fr.
³ Radiology Department, Claude Huriez Hospital, CHU Lille, Lille, France.
⁴ Department of Urology, Institut Mutualiste Montsouris, Paris, France.
⁵ University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France.
⁶ Department of Pathology, CHU Lille, Université de Lille, Lille, France.
⁷ CHU Lille, Department of Biostatistics, F59000, Lille, France.
⁸ AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France.
⁹ Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, Paris, France.
¹⁰ Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France.

PMID: 39256551
DOI: 10.1038/s41391-024-00885-1

Abstract

Background: 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.

Objective: This systematic review and meta-analysis aim to evaluate the accuracy of MRI in detecting early recurrence of localized prostate cancer following HIFU PGA.

Methods: Adhering to PRISMA guidelines, a comprehensive literature search was conducted until May 8^th 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.

Results: 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.

Conclusion: 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.

Publication types

Review