Post-Treatment Imaging in Focal Therapy: Understanding TARGET and PI-FAB Scoring Systems

TL;DR

This paper reviews two MRI scoring systems for evaluating prostate cancer after focal therapy, aiming to improve diagnostic accuracy and patient care.

Contribution

The paper provides a comparative review of the TARGET and PI-FAB scoring systems for post-focal therapy prostate cancer imaging.

Findings

TARGET and PI-FAB systems improve post-treatment imaging accuracy by distinguishing benign changes from cancer recurrence.

These systems standardize assessments and support clinical decision-making in focal therapy follow-up.

Further large-scale validation is needed to confirm the systems' effectiveness.

Abstract

As the adoption of focal therapy (FT) for prostate cancer (PCa) grows, the demand for accurate post-treatment imaging to monitor outcomes and detect residual or recurrent cancer increases. Traditional diagnostic systems like the Prostate Imaging Reporting and Data System (PI-RADS) are ill-suited for post-FT evaluations due to treatment-induced tissue changes. MRI-based scoring systems specific for evaluation after FT have been developed to address these challenges and improve post-FT imaging accuracy by distinguishing benign alterations from recurrence. The currently developed scoring systems are Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) and Prostate Imaging after Focal Ablation (PI-FAB). In this review, we describe and compare these two systems. These scoring systems standardize imaging assessments, enhance follow-up care, and support clinical decision-making. While promising, TARGET and PI-FAB require further large-scale validation to confirm their utility. Nevertheless, they represent critical advances in optimizing PCa management, particularly for patients undergoing FT, by improving diagnostic accuracy and guiding treatment decisions.

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