Pd39-09 the Trans-Atlantic Recommendations for Prostate Gland Evaluation With Mri After Focal Therapy (Target) International Consensus Recommendations

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (PD39)1 May 2024PD39-09 THE TRANS-ATLANTIC RECOMMENDATIONS FOR PROSTATE GLAND EVALUATION WITH MRI AFTER FOCAL THERAPY (TARGET) INTERNATIONAL CONSENSUS RECOMMENDATIONS Alexander Light, Nikhil N. Mayor, Emma Cullen, Jan van der Meulen, Taimur T. Shah, and Hashim U. Ahmed Alexander LightAlexander Light , Nikhil N. MayorNikhil N. Mayor , Emma CullenEmma Cullen , Jan van der MeulenJan van der Meulen , Taimur T. ShahTaimur T. Shah , and Hashim U. AhmedHashim U. Ahmed View All Author Informationhttps://doi.org/10.1097/01.JU.0001008924.16121.42.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After focal therapy for prostate cancer, patients require close surveillance in case of tumor recurrence. Prostate MRI is key, but there exists no robust guidance for its use. We used consensus methodology and an international, multi-disciplinary, expert panel to derive new recommendations for the conduct and interpretation of MRI post-focal therapy. METHODS: The RAND/UCLA Appropriateness Method was used to conduct a 2-round consensus study. 24 panellists from 7 countries across Europe and North America participated, comprising 13 radiologists, 10 urologists, and 1 pathologist. Focal therapy experience spanned 8 modalities, with cryotherapy (83%) and HIFU (75%) most common. Round 1 (December 2022) was conducted via correspondence, and Round 2 (January 2023) was a consensus meeting held in London, UK. During Round 2, 334 statements were discussed and scored by panelists with a 9-point Likert scale. Only statements rated with 'agreement' or 'disagreement' with 'consensus' were included in final recommendations. RESULTS: 82.1% of statements were scored with agreement/disagreement and consensus after Round 2. Key recommendations include performing routine MRI at 12 months post-ablation using a multiparametric protocol compliant with PI-RADS v2.1 technical standards. For MRI interpretation, PI-RADS scores should not be used to assess for recurrent cancer within the treatment zone. An alternative 5-point TARGET scoring system has been designed (Figure 1A). This incorporates a major DCE sequence and co-minor DWI and T2W sequences. Each sequence is scored out of 3 and an algorithm is used to determine the overall 5-point score. For DCE, focal nodular strong early enhancement was the most suspicious imaging finding (Figure 1B). Criteria for the minor DWI and T2W sequences could not be agreed. However, it was discussed that for DWI, focal high-signal on high b value images and low signal on ADC maps are typically suspicious. For T2W, intermediate signal intensity between low (fibrosis) and that of untreated prostate is typically suspicious. CONCLUSIONS: The TARGET expert consensus recommendations and the 5-point TARGET scoring system could improve MRI use post-focal ablation, and now requires multicenter validation. Source of Funding: Nil © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e816 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander Light More articles by this author Nikhil N. Mayor More articles by this author Emma Cullen More articles by this author Jan van der Meulen More articles by this author Taimur T. Shah More articles by this author Hashim U. Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...