Related Experiment Video
Updated: Jul 3, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Prostate cancer: Value of the PI-FAB score and volume-adjusted PSA density in recurrence assessment after HIFU
Clara Elsner1, Antonia M Pausch1, Toni Rabadi1
1Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zurich 8091, Switzerland.
Purpose:
To evaluate the diagnostic performance of the Prostate Imaging after Focal Ablation (PI-FAB) score on multiparametric MRI in combination with volume-adjusted PSA density (vaPSA-D, derived from volumetrically assessed residual vital prostate tissue) for detecting in-field recurrence after HIFU ablation of localized prostate cancer.
Methods:
In this retrospective single-center study, 117 men treated with HIFU underwent follow-up mpMRI and prostate biopsies at 6 (n = 99), 12 (n = 74), and 36 (n = 52) months. PI-FAB scores and vaPSA-D were assessed independently. Diagnostic performance was evaluated using biopsy-based histopathology as the reference standard.
Results:
PI-FAB demonstrated good diagnostic performance, particularly at 36 months (AUC 0.92). vaPSA-D showed increasing accuracy over time (AUC 0.64, 0.82, 0.84 at 6, 12, and 36 months; overall 0.78), outperforming PI-FAB at 12 months. Integrating vaPSA-D into PI-FAB subgroups significantly enhanced recurrence assessment: PI-FAB 1: sensitivity/specificity 75%/79% (threshold 0.14 ng/ml); PI-FAB ≥ 2: sensitivity/specificity 65%/85% (0.18 ng/ml); PI-FAB 3: sensitivity/specificity 67%/90% (0.18 ng/ml).
Conclusion:
Both PI-FAB and vaPSA-D provide reliable recurrence assessment after HIFU, with complementary strengths: PI-FAB performs best at later follow-up stages, whereas vaPSA-D maintains high sensitivity throughout. Their combined application offers the most accurate evaluation of post-HIFU recurrence and may help reduce unnecessary biopsies.
Insights
The Prostate Imaging after Focal Ablation (PI-FAB) score and volume-adjusted PSA density (vaPSA-D) reliably detect prostate cancer recurrence after HIFU ablation. Combining PI-FAB and vaPSA-D offers the most accurate assessment, potentially reducing unnecessary biopsies.
Area of Science:
- Oncology
- Radiology
- Urology
Background:
- HIFU ablation is a treatment for localized prostate cancer.
- Accurate detection of in-field recurrence post-HIFU is crucial for patient management.
- Multiparametric MRI (mpMRI) and PSA density are key tools in prostate cancer assessment.
Purpose of the Study:
- To evaluate the diagnostic performance of the PI-FAB score combined with vaPSA-D for detecting in-field recurrence after HIFU.
- To assess the accuracy of PI-FAB and vaPSA-D individually and in combination.
Main Methods:
- Retrospective study of 117 men treated with HIFU, with follow-up mpMRI and biopsies at 6, 12, and 36 months.
- PI-FAB scores and vaPSA-D were independently assessed.
- Diagnostic performance was evaluated against biopsy-proven histopathology.
Main Results:
- PI-FAB showed good performance (AUC 0.92 at 36 months).
- vaPSA-D accuracy increased over time (overall AUC 0.78), outperforming PI-FAB at 12 months.
- Combined PI-FAB and vaPSA-D significantly enhanced recurrence assessment with high sensitivity and specificity.
Conclusions:
- Both PI-FAB and vaPSA-D are reliable for post-HIFU recurrence assessment.
- PI-FAB excels at later follow-up, while vaPSA-D maintains high sensitivity throughout.
- Combined use offers the most accurate evaluation and may reduce unnecessary biopsies.
