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3-T multiparametric MRI characteristics of prostate cancer patients suspicious for biochemical recurrence after primary focal cryosurgery (hemiablation)

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We aimed to report on multiparametric MRI (mpMRI) characteristics of post-primary focal cryosurgery (PFC) patients suspected of biochemical recurrence (BCR) by the Phoenix criteria.


We retrospectively reviewed all patients at our institution who had undergone PFC. Prostate-specific antigen nadir was determined using 2 or more post-PFC values. Suspicion of BCR was determined using the Phoenix criteria (nadir + 2 ng/ml). At the discretion of the physician, pre-and post-PFC 3-T mpMRIs were obtained and in a few cases biopsies were performed.


Ninety (58.4%) of 154 consecutive patients who underwent PFC were included in our analysis and had a median (range) age and prostate volume of 66.5 (48–82) years and 40.5 (16–175) ml, respectively. Of those suspected of BCR (37/90, 41.1%), with a median time to BCR of 19.9 (7.0–38.5) months, 27 patients (73.0%) underwent a post-PFC mpMRI. Twenty-two (81.5%) of these mpMRIs were found with 24 suspicious lesions. A considerable number (9/24, 37.5%) of these lesions were located in the central gland of the prostate. Seven of 24 lesions exhibited adverse mpMRI characteristic; 4 (16.7%) had capsular contact, 2 (8.2%) showed frank extracapsular extension, and 1 (4.2%) showed seminal vesicle invasion. Five (45.5%) of 11 patients with positive post-PFC mpMRIs were positive on biopsy (4/5, 80% were clinically significant prostate cancer).


Post-PFC mpMRI, at Phoenix suspicion of BCR, may help identify a significant number of patients failing post-PFC.

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Fig. 1
Fig. 2
Fig. 3



Multiparametric magnetic resonance image


T-2 weighted image


Diffusion weighted image


Dynamic contrast enhancement


Apparent diffusion coefficient


Tumor capsular contact


Extracapsular extension


Prostate image reporting and data system


Primary focal cryosurgery


High-intensity focused ultrasound


Prostate cancer


Low risk


Intermediate risk


High risk


Transition zone


Central zone


Central gland


Peripheral zone


Biochemical recurrence


Prostate-specific antigen


Active surveillance


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Authors’ contribution

MK was involved in protocol, project development and manuscript writing. DMH was involved in the data collection/management. DJH was involved in the data collection/management. CCL read the MRIs, provided manuscript MRI images and edited the manuscript. KEK was involved in the data interpretation and manuscript editing. ATC edited the manuscript. AEK was involved in the manuscript editing and supervision.

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Correspondence to Michael Kongnyuy.

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The authors declare that they do not have any conflict of interest.


The Department of Urology at Winthrop University Hospital provided the funds needed for the study.

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All procedures performed in studies involving participants were in accordance with the ethical standards of the institutional and or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard.

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Informed consent was obtained from all individual participants involved in the study.

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Kongnyuy, M., Halpern, D.M., Liu, C.C. et al. 3-T multiparametric MRI characteristics of prostate cancer patients suspicious for biochemical recurrence after primary focal cryosurgery (hemiablation). Int Urol Nephrol 49, 1947–1954 (2017). https://doi.org/10.1007/s11255-017-1670-3

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  • Multiparametric MRI
  • Biochemical recurrence
  • Prostate cancer
  • Primary focal cryosurgery