The increasing use of focal therapy (FT) in localized prostate cancer (PCa) management requires a standardized MRI interpretation system to detect recurrent clinically significant PCa (csPCa). This pilot study evaluates the novel Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) and compares its performance to that of the Prostate Imaging after Focal Ablation (PI-FAB) system.
This retrospective study included 38 patients who underwent primary FT for localized PCa, with follow-up multiparametric MRI (mpMRI) and biopsy. Two radiologists assessed the mpMRIs using both PI-FAB and TARGET independently. Diagnostic performance metrics and area under the receiver operating characteristic curve (AUC) were calculated. Inter-reader and intrareader agreement were assessed using Cohen's κ and Kendall's τ.
14 patients had recurrent csPCa. PI-FAB showed high sensitivity (92.9% for both readers) and NPV (reader 1: 93.8%, reader 2: 92.9%) but moderate specificity (reader 1: 62.5%, reader 2: 54.2%). TARGET demonstrated lower sensitivity for one reader (reader 1: 78.6%, reader 2: 92.9%) but higher specificity (reader 1: 79.2%, reader 2: 62.5%) for both readers. Both systems displayed moderate inter-reader agreement (κ = 0.56 for PI-FAB, 0.57 for TARGET).
PI-FAB and TARGET exhibit similar performances in post-FT MRI. While PI-FAB had consistently high sensitivity, TARGET offered higher specificity for one reader. Moderate agreement levels demonstrate the viability of these systems in clinical settings and a promise for improvement.
Academic radiology. 2024 Oct 18 [Epub ahead of print]
Omer Tarik Esengur, David G Gelikman, Yan Mee Law, Enis C Yilmaz, Stephanie A Harmon, Maria J Merino, Sandeep Gurram, Peter L Choyke, Bradford J Wood, Peter A Pinto, Baris Turkbey
Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Department of Diagnostic Radiology, Singapore General Hospital, Singapore., Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD., Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: .