Open Access

ARTICLE

Implications of MRI contrast enhancement following focal prostate cancer cryoablation

James Wysock^1,*, Jesse Persily^1,*, Angela Tong², Eli Rapoport¹, Ben Zaslavsky¹, Majlinda Tafa¹, Herbert Lepor¹

1 Department of Urology, NYU Langone Health, New York, New York, USA
2 Department of Radiology, NYU Langone Health, New York, New York, USA
Address correspondence to Dr. Herbert Lepor, Department of Urology, NYU Langone Health, 222 East 41st Street, New York, NY 10016 USA

Canadian Journal of Urology 2024, 31(5), 11986-11991.

Abstract

Introduction: Local disease recurrence following focal therapy (FT) for prostate cancer may be due to failure to eradicate focal disease or development of disease in the untreated prostate (in- and out-of-field recurrences). Several studies suggest in-field contrast enhancement (CE) on post treatment multi-parametric (mp) MRI between 6-12 months following FT indicates residual disease. The present study assesses the incidence and oncologic implications of early CE observed following primary partial gland cryoablation (PPGCA).
Material and methods: The surveillance protocol for men enrolled in our prospective outcomes study following PPGCA included mpMRI at 6-12 months, 2 years, 3.5 years, and 5 years. All cases of in-field early CE were re reviewed retrospectively and graded using the previously described Prostate Imaging after Focal Ablation scoring system. All patients exhibiting early CE were re-evaluated by a single radiologist at 2-year mpMRI
Results: A total of 320 men enrolled in our PPGCA outcomes study had at least 6 months of follow up. Three hundred fifteen (98%) of these men had undergone post PPGCA mpMRI at 6-12 months. Of these men, 9 were found to have early in-field CE and 8 underwent repeat MRI at 2 years. In all 8 cases, the CE resolved on the 2-year mpMRI. Of these 8 patients, seven underwent repeat protocol biopsy at 2 years and in-field significant disease was detected in only 1 case.
Conclusions: The most compelling evidence that early CE is not indicative of prostate cancer recurrence is that all lesions resolved within 24 months. While incidence of early CE is low, its consistent resolution calls into question the clinical significance of this finding after PPGCA.

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