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MRI accuracy for recurrence after partial gland ablation with HIFU for localized prostate cancer. A systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases volume 28, pages 592–600 (2025)Cite this article

Subjects

Abstract

Background

Prostate cancer remains the most frequently diagnosed cancer among men. High-Intensity Focused Ultrasound (HIFU) has emerged as a thermal ablative technique for partial-gland-ablation (PGA), aiming to minimize collateral damage while maximizing tumor control. Monitoring after HIFU PGA relies on serial PSA testing, multiparametric-MRI, and biopsies. The diagnostic accuracy of MRI for clinically-significant cancer(csPCa) recurrence is challenging.

Objective

This systematic review and meta-analysis aim to evaluate the accuracy of MRI in detecting early recurrence of localized prostate cancer following HIFU PGA.

Methods

Adhering to PRISMA guidelines, a comprehensive literature search was conducted until May 8th 2024 using MEDLINE and Scopus. The inclusion criteria encompassed randomized controlled trials and cohort studies involving men diagnosed with localized prostate cancer who had as primary treatment HIFU PGA. The primary outcome measures included the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) of MRI for csPCa(ISUP ≥ 2) based on biopsy results. We pooled data from studies with sufficient csPCa and csPCa-free patients (≥5) post HIFU for statistical analysis.

Results

Fifteen studies meet the inclusion criteria, encompassing 1093 patients and 12 studies were eligible for meta-analysis. MRI sensitivity in detecting clinically-significant prostate cancer (csPCa) recurrence post HIFU PGA varied widely (0–89%), with a pooled sensitivity of 0.52 (95% CI:0.36–0.68). Specificity ranged from 44% to 100%, with a pooled specificity of 0.81 (95% CI:0.68–0.91). The pooled NPV was 0.82 (95% CI:0.72–0.90), and the pooled PPV was 0.50 (95% CI:0.35–0.65). Three studies reported in-field diagnostic performance with sensitivities ranging from 0.42 to 0.80 and specificities from 0.45 to 0.97.

Conclusion

MRI accuracy for clinically-significant recurrence after partial gland ablation with HIFU for localized prostate cancer shows low diagnostic performance in the treated lobe with pooled sensitivity of 0.52 (95% CI:0.36–0.68) and specificity of 0.81 (95% CI:0.68–0.91). Limits of this review include the low number of studies reporting about site of recurrence in or out of the treated lobe.

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Fig. 1: Prisma flow diagram.
Fig. 2
Fig. 3: Pooled performance of MRI alone to diagnose early recurrence of csPCa.

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Author information

Authors and Affiliations

  1. Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France

    Denis Séguier, Arnauld Villers & Jonathan Olivier

  2. University Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France

    Denis Séguier, Xavier Leroy, Arnauld Villers & Jonathan Olivier

  3. Radiology Department, Claude Huriez Hospital, CHU Lille, Lille, France

    Philippe Puech

  4. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    Eric Barret

  5. Department of Pathology, CHU Lille, Université de Lille, Lille, France

    Xavier Leroy

  6. CHU Lille, Department of Biostatistics, F59000, Lille, France

    Julien Labreuche

  7. AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France

    Raphael Renard Penna

  8. Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, Paris, France

    Guillaume Ploussard

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Contributions

DS and JO were responsible for conceptualization, data collection and writing. JL provided statistical analysis and methodological guidance. PP, EB, XL, RRP, GP, and AV contributed through senior editorial review. All authors reviewed and approved the final manuscript.

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Correspondence to Denis Séguier.

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Supplementary information

41391_2024_885_MOESM1_ESM.docx (download DOCX )

Supplementary Table 1: Leave-one-out Sensitivity analyses of the pooled performance of MRI alone to diagnose early recurrence of csPCa

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Séguier, D., Puech, P., Barret, E. et al. MRI accuracy for recurrence after partial gland ablation with HIFU for localized prostate cancer. A systematic review and meta-analysis. Prostate Cancer Prostatic Dis 28, 592–600 (2025). https://doi.org/10.1038/s41391-024-00885-1

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