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The following is a summary of “Combining Percentage Prostate-Specific Antigen Reduction and Multiparametric Magnetic Resonance Imaging to Reduce Unnecessary Biopsy After Focal Therapy With High-Intensity Focused Ultrasound for Prostate Cancer,” published in the February 2025 issue of International Journal of Urology by Hsieh et al. 

Researchers conducted a retrospective study to assess whether prostate-specific antigen (PSA) reduction and multiparametric magnetic resonance imaging (mpMRI) could identify cases where follow-up biopsy is unnecessary after focal therapy (FT) with high-intensity focused ultrasound (HIFU).  

They reviewed 90 men treated with FT, calculated percentage PSA reduction using PSA nadir within 6 months, and performed mpMRI at 6 months, followed by a routine biopsy. They used logistic regression to identify clinically significant prostate cancer (csPC) predictors and ROC analysis to assess the area under the curve (AUC). They calculated the diagnostic performance of percentage PSA reduction and mpMRI for csPC prediction. 

The results showed that 8 patients had csPC recurrence. Percentage PSA reduction (P = 0.033) and PI-RADS ≥3 (P = 0.02) predicted csPC. The AUC for mpMRI, PSA reduction, and their combination were 0.95, 0.816, and 0.982. PSA reduction <70% and PI-RADS ≥3 had sensitivity, specificity, PPV, and NPV of 87.5%, 69.5%, 21.9%, 98.3%, and 87.5%, 96.3%, 70%, 98.8%, respectively. Using PSA reduction <70% or PI-RADS ≥3 to select biopsy candidates could avoid 60% of biopsies without missing csPC. 

Investigators suggested avoiding routine biopsy at 6 months after FT with HIFU for patients with PSA reduction >70% and PI-RADS <3. 

Source: onlinelibrary.wiley.com/doi/10.1111/iju.70013