3-T multiparametric MRI characteristics of prostate cancer patients suspicious for biochemical recurrence after primary focal cryosurgery (hemiablation)

• Published in: International urology and nephrology Vol. 49; no. 11; pp. 1947 - 1954
• Main Authors: Kongnyuy, Michael, Halpern, Daniel M., Liu, Corinne C., Kosinski, Kaitlin E., Habibian, David J., Corcoran, Anthony T., Katz, Aaron E.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-11-2017; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Biopsy; Cryosurgery; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - diagnostic imaging; Nephrology; Prostate - pathology; Prostate cancer; Prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies; Seminal vesicle; Urology; Urology - Original Paper; Primary focal cryosurgery; Multiparametric MRI; Biochemical recurrence; Prostate cancer
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-017-1670-3

Introduction
We aimed to report on multiparametric MRI (mpMRI) characteristics of post-primary focal cryosurgery (PFC) patients suspected of biochemical recurrence (BCR) by the Phoenix criteria.
Methods
We retrospectively reviewed all patients at our institution who had undergone PFC. Prostate-specific antigen nadir was determined using 2 or more post-PFC values. Suspicion of BCR was determined using the Phoenix criteria (nadir + 2 ng/ml). At the discretion of the physician, pre-and post-PFC 3-T mpMRIs were obtained and in a few cases biopsies were performed.
Results
Ninety (58.4%) of 154 consecutive patients who underwent PFC were included in our analysis and had a median (range) age and prostate volume of 66.5 (48–82) years and 40.5 (16–175) ml, respectively. Of those suspected of BCR (37/90, 41.1%), with a median time to BCR of 19.9 (7.0–38.5) months, 27 patients (73.0%) underwent a post-PFC mpMRI. Twenty-two (81.5%) of these mpMRIs were found with 24 suspicious lesions. A considerable number (9/24, 37.5%) of these lesions were located in the central gland of the prostate. Seven of 24 lesions exhibited adverse mpMRI characteristic; 4 (16.7%) had capsular contact, 2 (8.2%) showed frank extracapsular extension, and 1 (4.2%) showed seminal vesicle invasion. Five (45.5%) of 11 patients with positive post-PFC mpMRIs were positive on biopsy (4/5, 80% were clinically significant prostate cancer).
Conclusion
Post-PFC mpMRI, at Phoenix suspicion of BCR, may help identify a significant number of patients failing post-PFC.