放疗后复发的前列腺癌患者占五分之一。前列腺磁共振成像(MRI)对复发性癌症的疗效尚未确定。此外，还需要新的微创挽救性局灶消融治疗的高质量数据。目的探讨前列腺MRI在前列腺癌放射治疗后复发诊断中的作用及挽救性病灶消融术在复发治疗中的作用。

predict试验是一项配对队列诊断研究，评估前列腺多参数MRI (mpMRI)和MRI靶向活检在复发癌检测中的作用，也是一项评估英国6个中心局灶消融的队列研究。共招募181例患者，其中155例纳入MRI分析，93例纳入局灶消融分析。主要结果是MRI和MRI靶向活检对癌症检测的敏感性，以及局灶消融后尿失禁。一个关键的次要结局是无进展生存期(PFS)。

全身分期显像显示128例(71%)患者有局部癌，13例(7%)患者仅累及盆腔淋巴结，38例(21%)患者有转移。mri靶向活检的敏感性为92%(95%可信区间[CI] 83-97%)。特异性和阳性预测值和阴性预测值分别为75% (95% CI 45-92%)、94% (95% CI 86-98%)和65% (95% CI 38-86%)。4例(6%)肿瘤被TTPM活检遗漏，6例(8%)被mri靶向活检遗漏。MRI检测任何癌症的总体灵敏度为94% (95% CI 88-98%)。特异性和阳性预测值和阴性预测值分别为18% (95% CI 7 ~ 35%)、80% (95% CI 73 ~ 87%)和46% (95% CI 19 ~ 75%)。在93例接受局灶消融的患者中，15例(16%)发生尿失禁，5例(5%)发生3级不良事件，无直肠损伤。中位随访时间为27个月(四分位范围18-36);24个月时总PFS为66%(四分位范围54-75%)。患者应接受前列腺MRI检查，同时进行系统和靶向活检，以优化癌症检测。前列腺内复发区域的局灶消融在大多数情况下保持了克制，具有良好的早期癌症控制。

Abstract

Background: Recurrent prostate cancer after radiotherapy occurs in one in five patients. The efficacy of prostate magnetic resonance imaging (MRI) in recurrent cancer has not been established. Furthermore, high-quality data on new minimally invasive salvage focal ablative treatments are needed.

Objective: To evaluate the role of prostate MRI in detection of prostate cancer recurring after radiotherapy and the role of salvage focal ablation in treating recurrent disease.

Design, setting, and participants: The FORECAST trial was both a paired-cohort diagnostic study evaluating prostate multiparametric MRI (mpMRI) and MRI-targeted biopsies in the detection of recurrent cancer and a cohort study evaluating focal ablation at six UK centres. A total of 181 patients were recruited, with 155 included in the MRI analysis and 93 in the focal ablation analysis.

Intervention: Patients underwent choline positron emission tomography/computed tomography and a bone scan, followed by prostate mpMRI and MRI-targeted and transperineal template-mapping (TTPM) biopsies. MRI was reported blind to other tests. Those eligible underwent subsequent focal ablation. An amendment in December 2014 permitted focal ablation in patients with metastases.

Outcome measurements and statistical analysis: Primary outcomes were the sensitivity of MRI and MRI-targeted biopsies for cancer detection, and urinary incontinence after focal ablation. A key secondary outcome was progression-free survival (PFS).

Results and limitations: Staging whole-body imaging revealed localised cancer in 128 patients (71%), with involvement of pelvic nodes only in 13 (7%) and metastases in 38 (21%). The sensitivity of MRI-targeted biopsy was 92% (95% confidence interval [CI] 83-97%). The specificity and positive and negative predictive values were 75% (95% CI 45-92%), 94% (95% CI 86-98%), and 65% (95% CI 38-86%), respectively. Four cancer (6%) were missed by TTPM biopsy and six (8%) were missed by MRI-targeted biopsy. The overall MRI sensitivity for detection of any cancer was 94% (95% CI 88-98%). The specificity and positive and negative predictive values were 18% (95% CI 7-35%), 80% (95% CI 73-87%), and 46% (95% CI 19-75%), respectively. Among 93 patients undergoing focal ablation, urinary incontinence occurred in 15 (16%) and five (5%) had a grade ≥3 adverse event, with no rectal injuries. Median follow-up was 27 mo (interquartile range 18-36); overall PFS was 66% (interquartile range 54-75%) at 24 mo.

Conclusions: Patients should undergo prostate MRI with both systematic and targeted biopsies to optimise cancer detection. Focal ablation for areas of intraprostatic recurrence preserves continence in the majority, with good early cancer control.

原文链接

pubmed.ncbi.nlm.nih.gov/35370021/

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