Pd39-07 Diagnostic Accuracy of Post-Cryoablation Mri for Residual Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (PD39)1 May 2024PD39-07 DIAGNOSTIC ACCURACY OF POST-CRYOABLATION MRI FOR RESIDUAL PROSTATE CANCER Piroz Bahar, Eugene Oh, Karan Desai, Matthew Jordan, Matthew Davenport, Jeffrey S. Montgomery, and Arvin K. George Piroz BaharPiroz Bahar , Eugene OhEugene Oh , Karan DesaiKaran Desai , Matthew JordanMatthew Jordan , Matthew DavenportMatthew Davenport , Jeffrey S. MontgomeryJeffrey S. Montgomery , and Arvin K. GeorgeArvin K. George View All Author Informationhttps://doi.org/10.1097/01.JU.0001008924.16121.42.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Assessing oncological success following focal ablation for prostate cancer (PCa) includes PSA response and imaging. However, the value of protocol biopsy remains uncertain. Consensus recommendations include follow-up multi-parametric MRI (mpMRI) and biopsy despite variable imaging quality, interpretation, and biopsy performance. We aim to determine mpMRI performance characteristics post-ablation for in-field (within the ablation zone) failure following focal cryoablation. METHODS: Patients receiving focal cryoablation from 01/01/2017 to 04/21/2023 were enrolled in a multi-institutional, IRB-approved, prospective registry. Per protocol, PSA, mpMRI, and ultrasound-MR fusion biopsy of the ablation bed were obtained at 6 months post-ablation. Residual PCa was suspected on mpMRI if there was persistent enhancement and impeded diffusion within the intended ablation zone. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of post-ablation mpMRI for Gleason Grade Group (GG) ≥2 PCa was calculated. Chi-squared test was used to perform bivariate analysis. RESULTS: 108 patients undergoing 118 cryoablations were enrolled. Patient-level characteristics are presented in Table 1. Post-primary ablation mpMRI and biopsy were performed in 91 patients; 10 underwent repeat cryoablation. Seven underwent post-repeat ablation mpMRI and biopsy (N=98 post-ablation events). Post-ablation mpMRI showed possible residual cancer in 11.2% (11/98). Post-ablation biopsy of the target lesion showed GG≥2 PCa in 10.2% (10/98) patients. MpMRI sensitivity, specificity, PPV, and NPV for detecting GG≥2 PCa post-ablation were 71.4%, 95.3%, 55.6%, and 97.6%, respectively. Primary analysis showed a significant association between suspicion of residual disease on MRI and biopsy detection of GG≥2 PCa p<0.0001. Secondary analysis excluding post-repeat cryoablation data (N=91) was 71.4%, 94.9%, 55.6%, and 97.4%, respectively. CONCLUSIONS: Post-ablation mpMRI has a high NPV, specificity, and sensitivity for detecting residual GG≥2 PCa and when negative, could be used to defer near-term "protocol" biopsy. Future investigation into causes of false positive and false negative post-ablation mpMRI will help identify those who warrant per-protocol biopsy. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e815 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Piroz Bahar More articles by this author Eugene Oh More articles by this author Karan Desai More articles by this author Matthew Jordan More articles by this author Matthew Davenport More articles by this author Jeffrey S. Montgomery More articles by this author Arvin K. George More articles by this author Expand All Advertisement PDF downloadLoading ...