MRI and targeted biopsies compared to transperineal mapping biopsies for targeted ablation in recurrent prostate cancer after radiotherapy: primary outcomes of the FORECAST trial (FOcal RECurrent Assessment and Salvage Treatment).
BAUS ePoster online library. Shah T. 06/21/21; 318995; p1-7
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Dr. Taimur Shah
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Abstract
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Background: Radiotherapy is a common and effective treatment for localised prostate cancer. However, recurrence can occur in 10-15% at 5-years. Accurately localising and ablating areas of recurrence within the prostate might be effective with fewer side-effects. The FORECAST trial assessed this diagnostic and treatment pathway (NCT01883128, REC_13/LO/1401).
Methods: We first compared, accuracy of multi-parametric MRI (mp-MRI) and MRI-targeted biopsy to a transperineal mapping (TTPM) in 181 with suspicion of recurrence after radiotherapy at 6 UK centres (Apr/2014-Jan/2018). We then assessed, functional and oncological outcomes of focal ablation in 93 men with localised or metastatic disease using cryotherapy or HIFU.
Results: Re-staging imaging showed localised disease in 128 (71%), nodal in 13 (7%), and metastatic in 38 (21%). Cancer detection increased with Likert scores. Overall sensitivity of mpMRI was 81% (95%CI 73-88%) using Likert score 4-5 as a positive test. Specificity, positive and negative predictive values, were 88% (95%CI 73-98%), 96% (95%CI 90-99%) and 57% (95%CI 42-70%). Sensitivity of MRI-targeted biopsy was 92% (95%CI 83-97%). Specificity, positive and negative predictive values, were 75% (95%CI 45-92%), 94% (95%CI 86-98%) and 65% (95%CI 38-86%). 4/72 (6%) cancers were missed on TTPM-biopsy and 6/72 (8%) were missed on targeted-biopsies. 93 men underwent focal ablation, urinary continence was preserved in 78/93 (84%). At median follow-up of 27.8 [SD 1.3] months, progression-free-survival and metastases-free-survival (localised disease) were 66% [54-75] and 80% [95%CI 68–88] at 24-months.
Conclusion: Prostate mpMRI and MRI-targeted biopsies can accurately detect and localise recurrent cancer. Focal ablation preserves continence with good cancer control.
Methods: We first compared, accuracy of multi-parametric MRI (mp-MRI) and MRI-targeted biopsy to a transperineal mapping (TTPM) in 181 with suspicion of recurrence after radiotherapy at 6 UK centres (Apr/2014-Jan/2018). We then assessed, functional and oncological outcomes of focal ablation in 93 men with localised or metastatic disease using cryotherapy or HIFU.
Results: Re-staging imaging showed localised disease in 128 (71%), nodal in 13 (7%), and metastatic in 38 (21%). Cancer detection increased with Likert scores. Overall sensitivity of mpMRI was 81% (95%CI 73-88%) using Likert score 4-5 as a positive test. Specificity, positive and negative predictive values, were 88% (95%CI 73-98%), 96% (95%CI 90-99%) and 57% (95%CI 42-70%). Sensitivity of MRI-targeted biopsy was 92% (95%CI 83-97%). Specificity, positive and negative predictive values, were 75% (95%CI 45-92%), 94% (95%CI 86-98%) and 65% (95%CI 38-86%). 4/72 (6%) cancers were missed on TTPM-biopsy and 6/72 (8%) were missed on targeted-biopsies. 93 men underwent focal ablation, urinary continence was preserved in 78/93 (84%). At median follow-up of 27.8 [SD 1.3] months, progression-free-survival and metastases-free-survival (localised disease) were 66% [54-75] and 80% [95%CI 68–88] at 24-months.
Conclusion: Prostate mpMRI and MRI-targeted biopsies can accurately detect and localise recurrent cancer. Focal ablation preserves continence with good cancer control.
Background: Radiotherapy is a common and effective treatment for localised prostate cancer. However, recurrence can occur in 10-15% at 5-years. Accurately localising and ablating areas of recurrence within the prostate might be effective with fewer side-effects. The FORECAST trial assessed this diagnostic and treatment pathway (NCT01883128, REC_13/LO/1401).
Methods: We first compared, accuracy of multi-parametric MRI (mp-MRI) and MRI-targeted biopsy to a transperineal mapping (TTPM) in 181 with suspicion of recurrence after radiotherapy at 6 UK centres (Apr/2014-Jan/2018). We then assessed, functional and oncological outcomes of focal ablation in 93 men with localised or metastatic disease using cryotherapy or HIFU.
Results: Re-staging imaging showed localised disease in 128 (71%), nodal in 13 (7%), and metastatic in 38 (21%). Cancer detection increased with Likert scores. Overall sensitivity of mpMRI was 81% (95%CI 73-88%) using Likert score 4-5 as a positive test. Specificity, positive and negative predictive values, were 88% (95%CI 73-98%), 96% (95%CI 90-99%) and 57% (95%CI 42-70%). Sensitivity of MRI-targeted biopsy was 92% (95%CI 83-97%). Specificity, positive and negative predictive values, were 75% (95%CI 45-92%), 94% (95%CI 86-98%) and 65% (95%CI 38-86%). 4/72 (6%) cancers were missed on TTPM-biopsy and 6/72 (8%) were missed on targeted-biopsies. 93 men underwent focal ablation, urinary continence was preserved in 78/93 (84%). At median follow-up of 27.8 [SD 1.3] months, progression-free-survival and metastases-free-survival (localised disease) were 66% [54-75] and 80% [95%CI 68–88] at 24-months.
Conclusion: Prostate mpMRI and MRI-targeted biopsies can accurately detect and localise recurrent cancer. Focal ablation preserves continence with good cancer control.
Methods: We first compared, accuracy of multi-parametric MRI (mp-MRI) and MRI-targeted biopsy to a transperineal mapping (TTPM) in 181 with suspicion of recurrence after radiotherapy at 6 UK centres (Apr/2014-Jan/2018). We then assessed, functional and oncological outcomes of focal ablation in 93 men with localised or metastatic disease using cryotherapy or HIFU.
Results: Re-staging imaging showed localised disease in 128 (71%), nodal in 13 (7%), and metastatic in 38 (21%). Cancer detection increased with Likert scores. Overall sensitivity of mpMRI was 81% (95%CI 73-88%) using Likert score 4-5 as a positive test. Specificity, positive and negative predictive values, were 88% (95%CI 73-98%), 96% (95%CI 90-99%) and 57% (95%CI 42-70%). Sensitivity of MRI-targeted biopsy was 92% (95%CI 83-97%). Specificity, positive and negative predictive values, were 75% (95%CI 45-92%), 94% (95%CI 86-98%) and 65% (95%CI 38-86%). 4/72 (6%) cancers were missed on TTPM-biopsy and 6/72 (8%) were missed on targeted-biopsies. 93 men underwent focal ablation, urinary continence was preserved in 78/93 (84%). At median follow-up of 27.8 [SD 1.3] months, progression-free-survival and metastases-free-survival (localised disease) were 66% [54-75] and 80% [95%CI 68–88] at 24-months.
Conclusion: Prostate mpMRI and MRI-targeted biopsies can accurately detect and localise recurrent cancer. Focal ablation preserves continence with good cancer control.
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