"'HIFU' Treatment MRI Helps Predict Recurrence in Prostate Cancer Patients"

Professor Hyungwoo Ahn and Hakmin Lee Team at Bundang Seoul National University Hospital

Professor Hyungwoo Ahn (left), Department of Radiology, and Professor Hakmin Lee, Department of Urology, Bundang Seoul National University Hospital.

[Asia Economy Reporter Lee Gwan-ju] A study has found that prostate magnetic resonance imaging (MRI) can help predict the likelihood of recurrence in patients treated with the prostate cancer treatment method called High-Intensity Focused Ultrasound (HIFU).

The research team led by Professor Ahn Hyung-woo from the Department of Radiology and Professor Lee Hak-min from the Department of Urology at Bundang Seoul National University Hospital announced on the 14th that these findings were published in the leading academic journal in the prostate field, Prostate Cancer and Prostate Diseases.

HIFU treatment involves inserting a device into the body through the anus and concentrating high-intensity ultrasound energy on a single spot to remove only the cancerous tissue at a high temperature. Compared to surgical treatment, which removes cancer tissue by cutting the skin, HIFU has the advantage of fewer aftereffects and side effects.

HIFU treatment has a relatively high probability of cancer recurrence, so continuous prognosis monitoring is necessary. Conventional prostate MRI uses two of the three imaging sequences included in the test results (T2WI, DWI, DCE)?specifically T2WI and DWI?applying the recurrence reading criteria (PI-RADs). However, after HIFU treatment, scars and deformation occur inside the prostate, making it difficult to predict recurrence using the existing reading criteria.

The research team applied a new recurrence prediction score using DWI and DCE images from MRI, considering the prostate condition after HIFU treatment. Two urology specialists evaluated the likelihood of cancer recurrence on a five-point scale. From August 2019 to April last year, they conducted biopsies on 110 patients who underwent HIFU treatment for prostate cancer and compared and analyzed the recurrence scores to assess diagnostic performance.

Analysis results showed that the new recurrence score demonstrated a high specificity of 97% in patient-level analysis and 87% in region-level analysis, where the prostate tissue was divided into six areas. This means that when the MRI test result is negative (no recurrence), the biopsy also has a high probability of being negative. Utilizing this high specificity of the MRI recurrence score can effectively monitor prognosis after HIFU treatment. However, the sensitivity, which is the probability that both MRI and biopsy results are positive, was low, so the research team explained that it can be used as an auxiliary tool to the standard diagnostic method, biopsy.

Professor Ahn said, "Considering the possibility of errors in biopsy, suspicious recurrence findings on MRI after HIFU treatment can be clinically significant," adding, "If recurrence is suspected on MRI but not detected in biopsy, the possibility of a false negative should be kept in mind." Professor Lee added, "Compared to the past, auxiliary treatments and tests such as HIFU and MRI have increased, reducing unnecessary surgeries and the complications and side effects caused by them," and "Early detection of recurrence through continuous MRI follow-up will enable effective treatment."

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