Diagnostic Performance of 68Ga-PSMA-11 PET/CT Versus Multiparametric MRI for Detection of Intraprostatic Radiorecurrent Prostate Cancer

Magnetic Resonance Imaging Techniques for Post-Treatment Evaluation After External Beam Radiation Therapy of Prostate Cancer: Narrative Review

Background/Objectives: This study aimed to investigate the prognostic value of advanced techniques of magnetic resonance imaging (MRI) biochemical recurrence (BCR) after radiotherapy in patients with prostate cancer (PCa). Methods: A comprehensive literature review was conducted to evaluate the role of MRI in detecting BCR of PCa patients after external beam radiation therapy. Results: National guidelines do not recommend imaging techniques in clinical follow-up PCa. However, in 2021, the European Association of Urogenital Radiology (ESUR), the European Association of Urological Imaging (ESUI), and the PI-RADS Steering Committee introduced the Prostate Imaging for Recurrence Reporting (PI-RR) system. PI-RR incorporates the MRI biomarkers in the post-treatment process. In the last decade, a growing number of clinical researchers have investigated the role of various MRI techniques in BCR. Conclusions: The integration of advanced MRI technologies into clinical routine marks the beginning of a new era of BCR with accuracy.

The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations

BACKGROUND AND OBJECTIVE

Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy.

METHODS

A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement.

KEY FINDINGS AND LIMITATIONS

In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting.

PATIENT SUMMARY

Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.