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Updated: May 15, 2025

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound

Published on: March 21, 2025

Routine prostate biopsies not needed after cryotherapy if surveillance MRI is normal.

Herbert Lepor¹, Jesse Persily¹, Samuel Parry¹

¹Department of Urology, NYU Grossman School of Medicine, New York, NY, USA.

BJU International

|May 14, 2025

Summary

This summary is machine-generated.

Magnetic resonance imaging (MRI) visible prostate cancer after focal therapy is less likely to be clinically significant than MRI invisible cancer. Avoiding biopsies in most negative MRI cases can reduce surveillance costs and morbidity.

Keywords:

MRI invisible prostate cancer MRI visible prostate cancer focal therapy mpMRI partial gland cryoablation prostate cancer prostate cancer disease recurrence

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Area of Science:

Urology
Oncology
Radiology

Background:

Ablative focal therapy (AFT) is an option for intermediate-risk prostate cancer (PCa).
Post-treatment surveillance strategies, including MRI and biopsy, are crucial for monitoring recurrence.
Distinguishing between MRI-visible (MRIv) and MRI-invisible (MRIi) cancers is important for risk stratification.

Purpose of the Study:

To compare the detection rate and pathological features of MRIv versus MRIi prostate cancers.
To evaluate the clinical significance of detected cancers after AFT.
To assess the impact of MRI findings on surveillance strategies.

Main Methods:

Retrospective analysis of 305 men undergoing primary partial gland cryoablation (PPGCA) for intermediate-risk PCa.
Inclusion criteria: MRI PI-RADS 2-5, unilateral intermediate-risk disease, no gross extraprostatic extension, no contralateral significant disease, and ≥6 months follow-up.
MRI performed at 6, 24, 42, and 60 months; biopsy indicated by evolving criteria; Gleason pattern 4 (GP4) defined clinically significant PCa recurrence (csPCaR).

Main Results:

Of 665 post-treatment MRIs, 13.1% were positive for csPCaR.
Clinically significant PCa detection rate (csPCaDR) was 43.5% for positive MRI and 10.6% for negative MRI.
Median GP4 length was 2.6 mm for MRIv vs 0.6 mm for MRIi csPCaR (P=0.08).
MRIi csPCaRs were more likely to be managed with continued active surveillance (44% vs 14% for MRIv, P=0.03).

Conclusions:

MRI-invisible cancers after PPGCA are less likely to be clinically significant.
Avoiding biopsies in most negative MRI cases can safely reduce surveillance costs and morbidity.
This approach supports a more tailored surveillance strategy post-focal therapy.