title: Prostatic cancer surveillance following whole-gland high-intensity focused ultrasound: comparison of MRI and prostate-specific antigen for detection of residual or recurrent disease.
abstract: OBJECTIVE
  This retrospective study compares dynamic contrast-enhanced (DCE) MRI with the serial prostate-specific antigen (PSA) measurement for detection of residual disease following whole-gland high-intensity focused ultrasound (HIFU) therapy of prostate cancer.
  
  
  METHODS
  Patients in whom post-HIFU DCE-MRI was followed within 3 months by ultrasound-guided transrectal biopsy were selected from a local database. 26 patients met the study inclusion criteria. Serial PSA levels following HIFU and post-HIFU follow-up MRI were retrieved for each patient. Three radiologists unaware of other investigative results independently assessed post-HIFU MRI studies for the presence of cancer, scoring on a four-point scale (1, no disease; 2, probably no disease; 3, probably residual disease; and 4, residual disease). Sensitivity, specificity and receiver operating characteristic (ROC) analysis were performed for each reader, post-HIFU PSA nadir and pre-biopsy PSA level thresholds of >0.2 and >0.5 ng ml(-1).
  
  
  RESULTS
  The sensitivity of DCE-MRI for detection of residual disease for the three readers ranged between 73% and 87%, and the specificity between 73% and 82%. There was good agreement between readers (κ = 0.69-0.77). The sensitivity and specificity of PSA thresholds was 60-87% and 73-100%, respectively. The area under the ROC curve was greatest for pre-biopsy PSA (0.95).
  
  
  CONCLUSIONS
  DCE-MRI performed following whole-gland HIFU has similar sensitivity and specificity and ROC performance to serial PSA measurements for detection of residual or recurrent disease.
authors.affiliation: Department of Radiology, University College London Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Punwani
authors.forename: M
authors.initials: M
authors.lastname: Emberton
authors.forename: M
authors.initials: M
authors.lastname: Walkden
authors.forename: A
authors.initials: A
authors.lastname: Sohaib
authors.forename: A
authors.initials: A
authors.lastname: Freeman
authors.forename: H
authors.initials: H
authors.lastname: Ahmed
authors.forename: C
authors.initials: C
authors.lastname: Allen
authors.forename: A
authors.initials: A
authors.lastname: Kirkham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D018365:Neoplasm, Residual; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen