Abstract
OBJECTIVE
To assess the qualitative and quantitative changes on prostate multiparametric magnetic
resonance imaging (mpMRI) following partial gland ablation (PGA) with cryotherapy
and correlate with histopathology.
METHODS
We used 3D Slicer to generate prostate models and segment ipsilateral (treated) and
contralateral peripheral and transition zones in 10 men who underwent MRI/transrectal
ultrasound fusion-guided PGA during 2017-2018. Pre- and post-PGA volumes of prostate
segments were compared. Post-PGA mpMRI were categorized according to PI-RADS v2 and
treatment response on mpMRI was assessed in a manner similar to the radiology evaluation
framework following liver lesion ablation.
RESULTS
Median volume of ipsilateral peripheral and transition zones decreased from 10.9 mL
and 13.0 mL to 7.2 mL and 10.8 mL (P = .005), respectively. Median volume of contralateral peripheral and transition zones
also decreased from 12.1 mL and 12.5 mL to 9.9 mL to 10.4 mL (P = .005), respectively. Five men had clinically significant disease (Grade group ≥2)
on post-PGA biopsy (3 within treatment field and 2 outside). Of the men with clinically
significant prostate cancer, mpMRI revealed PI-RADS 3 lesions in 2. However, the treatment
response framework did not detect residual disease.
CONCLUSION
PGA results in asymmetrical and significant reductions in prostate volume. Our results
highlight the need for a separate assessment framework to enable standardization of
the interpretation and reporting of post-PGA surveillance mpMRI. Moreover, our findings
have significant implications for MRI-targeted surveillance biopsy following PGA with
cryotherapy.
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Article info
Publication history
Published online: January 15, 2020
Accepted:
January 6,
2020
Received:
October 9,
2019
Footnotes
Funding: JCH is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
