Treatment Outcomes of Partial Gland Ablation for Prostate Cancer: Evaluating PSA, MRI, Ultrasound, and Biopsy Metrics

Following focal therapy (FT) for prostate cancer (PCa), a study aimed to determine whether changes in MRI or PSA levels could effectively replace biopsy for assessing treatment outcomes. The research involved 309 men with Grade Group 2 (GG2) or Grade Group 3 (GG3) PCa who underwent FT between 2016 and 2022, specifically utilizing High-Intensity Focused Ultrasound (HIFU) or cryotherapy. Baseline, 6-month, and 18-month follow-up assessments included MRI-guided biopsy (MRGB), targeted, and systematic biopsies to evaluate the presence of clinically significant PCa (csPCa). At the 6-month follow-up, 261 men completed biopsies, revealing that 72% of them had successful FT with no csPCa, while 28% had failed treatment. MRI lesions were no longer visible in 79% of successful cases, while 72% of the failures still exhibited lesions. Although PSA levels decreased by more than 50% in a majority of both successful and failed treatments, the differences were not statistically significant. The study found that MRI had a sensitivity of 28% and specificity of 79%, while PSA showed a sensitivity of 46% and specificity of 67%. The combined sensitivity of using both MRI and PSA to suggest the absence of csPCa was 73% with a specificity of 75%. Ultimately, the findings indicate that the presence of residual csPCa is more accurately determined by MRGB rather than relying on PSA or MRI metrics, highlighting that FT may have a suppressive effect on prostate markers independent of its anti-neoplastic impact.