Target volume delineations for prostate cancer (PCa) salvage radiotherapy (SRT) after radical prostatectomy are usually drawn in the absence of visibly recurrent disease. Ga-labeled prostate-specific membrane antigen (PSMA-11) PET/CT detects recurrent PCa with sensitivity superior to standard-of-care imaging at serum prostate-specific antigen (PSA) values low enough to affect target volume delineations for routine SRT. Our objective was to map the recurrence pattern of PCa early biochemical recurrence (BCR) after radical prostatectomy withGa-PSMA-11 PET/CT in patients with serum PSA levels of less than 1 ng/mL, determine how often consensus clinical target volumes (CTVs) based on the Radiation Therapy Oncology Group (RTOG) guidelines cover Ga-PSMA-11 PET/CT-defined disease, and assess the potential impact ofGa-PSMA-11 PET/CT on SRT. This was a post hoc analysis of an intention-to-treat population of 270 patients who underwentGa-PSMA-11 PET/CT at 4 institutions for BCR after prostatectomy without prior radiotherapy at a PSA level of less than 1 ng/mL. RTOG consensus CTVs that included both the prostate bed and the pelvic lymph nodes were contoured on the CT dataset of the PET/CT image by a radiation oncologist masked to the PET component. Ga-PSMA-11 PET/CT images were analyzed by a nuclear medicine physician.Ga-PSMA-11-positive lesions not covered by planning volumes based on the consensus CTVs were considered to have a potential major impact on treatment planning. The median PSA level at the time ofGa-PSMA-11 PET/CT was 0.48 ng/mL (range, 0.03-1 ng/mL). One hundred thirty-two of 270 patients (49%) had a positive Ga-PSMA-11 PET/CT result. Fifty-two of 270 (19%) had at least one PSMA-11-positive lesion not covered by the consensus CTVs. Thirty-three of 270 (12%) had extrapelvic PSMA-11-positive lesions, and 19 of 270 (7%) had PSMA-11-positive lesions within the pelvis but not covered by the consensus CTVs. The 2 most commonGa-PSMA-11-positive lesion locations outside the consensus CTVs were bone (23/52, 44%) and perirectal lymph nodes (16/52, 31%). Post hoc analysis ofGa-PSMA-11 PET/CT implied a major impact on SRT planning in 52 of 270 patients (19%) with PCa early BCR (PSA < 1.0 ng/mL). This finding justifies a randomized imaging trial of SRT with or without Ga-PSMA-11 PET/CT investigating its potential benefit on clinical outcome.

Magnetic resonance (MR) examinations of men with prostate cancer are most commonly performed for detecting, characterizing, and staging the extent of disease to best determine diagnostic or treatment strategies, which range from biopsy guidance to active surveillance to radical prostatectomy. Given both the exam's importance to individual treatment plans and the time constraints present for its operation at most institutions, it is essential to perform the study effectively and efficiently. This article reviews the most commonly employed modern techniques for prostate cancer MR examinations, exploring the relevant signal characteristics from the different methods discussed and relating them to intrinsic prostate tissue properties. Also, a review of recent articles using these methods to enhance clinical interpretation and assess clinical performance is provided.

Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Standard-of-care imaging for initial staging of prostate cancer (PCa) underestimates disease burden. Prostate-specific membrane antigen (PSMA) PET/CT detects PCa metastasis with superior accuracy, having a potential impact on the planning of definitive radiation therapy (RT) for nonmetastatic PCa. Our objectives were to determine how often definitive RT planning based on standard target volumes covers Ga-PSMA-11 PET/CT-defined disease and to assess the potential impact ofGa-PSMA-11 PET/CT on definitive RT planning. This was a post hoc analysis of an intention-to-treat population of 73 patients with localized PCa without prior local therapy who underwentGa-PSMA PET/CT for initial staging as part of an investigational new drug trial. Eleven of the 73 were intermediate-risk (15%), 33 were high-risk (45%), 22 were very-high-risk (30%), and 7 were N1 (9.5%). Clinical target volumes (CTVs), which included the prostate, seminal vesicles, and (in accord with the Radiation Therapy Oncology Group consensus guidelines) pelvic lymph nodes (LNs), were contoured on the CT portion of the PET/CT images by a radiation oncologist masked to the PET findings. Ga-PSMA-11 PET/CT images were analyzed by a nuclear medicine physician.Ga-PSMA-11-positive lesions not covered by planning volumes based on the CTVs were considered to have a major potential impact on treatment planning. All patients had one or moreGa-PSMA-11-positive primary prostate lesions. Twenty-five (34%) and 7 (9.5%) of the 73 patients had Ga-PSMA-11-positive pelvic LN and distant metastases, respectively. The sites of LN metastases in decreasing order of frequency were external iliac (20.5%), common iliac (13.5%), internal iliac (12.5%) obturator (12.5%), perirectal (4%), abdominal (4%), upper diaphragm (4%), and presacral (1.5%). The median size of the LN lesions was 6 mm (range, 4-24 mm). RT planning based on the CTVs covered 69 (94.5%) of the 73 primary lesions and 20 (80%) of the 25 pelvic LN lesions, on a per-patient analysis. Ga-PSMA-11 PET/CT had a major impact on intended definitive RT planning for PCa in 12 (16.5%) of the 73 patients whose RT fields covered the prostate, seminal vesicles, and pelvic LNs and in 25 (37%) of the 66 patients whose RT fields covered the prostate and seminal vesicles but not the pelvic LNs.

Breast RT is associated with misconceptions and fears. Patients' experiences with modern breast RT appear to be superior to expectations, and the majority of patients in the current study agreed that their initial negative impressions were unfounded. Cancer 2018;124:1673-81. © 2018 American Cancer Society.

Purpose To investigate whether 3T multiparametric endorectal MRI (erMRI) can add information to established predictors regarding occult extraprostatic or high-grade prostate cancer (PC) in men with clinically localized PC. Methods and Materials At a single academic medical center, this retrospective study’s cohort included 118 men with clinically localized PC who underwent 3T multiparametric erMRI followed by radical prostatectomy (RP) from 2008 to 2011. Multivariable logistic regression analyses in all men and in 100 with favorable-risk PC addressed whether erMRI evidence of T3 disease was associated with prostatectomy T3 or Gleason score (GS) 8–10 (in patients with biopsy GS ≤ 7) PC, adjusting for age, PSA level, clinical T-category, biopsy GS, and percent positive biopsies. Results The accuracy of erMRI prediction of extracapsular extension and seminal vesicle invasion was 75% and 95%, respectively. For all men, erMRI evidence of a T3 lesion vs. T2 was associated with an increased odds of having pT3 disease (adjusted odds ratio (AOR) 4.81, 95% confidence interval (CI) (1.36, 16.98), p=0.015) and pGS 8–10 (AOR 5.56, (1.10, 28.18), p=0.038). In the favorable-risk population, these results were AOR 4.14, (1.03, 16.56), p=0.045 and AOR 7.71, (1.36, 43.62), p=0.021, respectively. Conclusions 3T multiparametric erMRI in men with favorable-risk PC provides information beyond that contained in known preoperative predictors about the presence of occult extraprostatic and/or high-grade PC. If validated in additional studies, this information can be used to counsel men planning to undergo RP or radiotherapy (RT) about the possible need for adjuvant RT or the utility of adding hormone therapy, respectively.

Background We evaluated priorities, expectations, and regret among patients treated on a phase II trial of de‐escalated chemoradiation for human papillomavirus (HPV)‐positive oropharyngeal cancer. Methods Eligibility included stage III/IV squamous cell carcinoma of the oropharynx, p16‐positivity, age ≥18 years, and Zubrod score 0‐1. Participants were surveyed with validated measures evaluating their treatment experience. Results Twenty‐four of 27 (89%) patients participated with a median follow‐up of 24 months. Twenty‐three subjects (96%) selected “being cured” or “living as long as possible” as top priority. No patient reported any regret about the decision to enroll on a de‐escalation protocol. Sixteen participants (67%) found retrospectively reported long‐term swallowing function to be either better than or as originally expected. Conclusions These data offer a baseline landscape of perspectives and priorities for patients treated with de‐escalation for HPV‐positive oropharyngeal carcinoma and provide support to the fundamental premise underlying ongoing efforts to establish a new standard of care.

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