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.
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.
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.
The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting.
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.
European urology. 2024 Mar 21 [Epub ahead of print]
Alexander Light, Nikhil Mayor, Emma Cullen, Alex Kirkham, Anwar R Padhani, Manit Arya, Joyce G R Bomers, Tim Dudderidge, Behfar Ehdaie, Alex Freeman, Stephanie Guillaumier, Richard Hindley, Amish Lakhani, Douglas Pendse, Shonit Punwani, Ardeshir R Rastinehad, Olivier Rouvière, Rafael Sanchez-Salas, Ivo G Schoots, Heminder K Sokhi, Henry Tam, Clare M Tempany, Massimo Valerio, Sadhna Verma, Geert Villeirs, Jan van der Meulen, Hashim U Ahmed, Taimur T Shah
Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK., Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK., Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK., Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands., Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, Victoria Hospital, NHS Fife, Kirkcaldy, UK., Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK., Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK., The Smith Institute for Urology at Lenox Hill, New York, NY, USA., Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France., Division of Urology, Department of Surgery, McGill University, Montreal, Canada., Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK., Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Urology, Geneva University Hospitals, Geneva, Switzerland., Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA., Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium., Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK., Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: .