DCE and DW MRI in monitoring response to androgen deprivation therapy in patients with prostate cancer: A feasibility study

Abstract

Androgen deprivation therapy (ADT) is a key primary treatment for advanced and metastatic prostate cancer and is an important neoadjuvant before radiotherapy. We evaluated 3.0 T dynamic contrast-enhanced MRI and diffusion-weighted (DW) MRI in monitoring ADT response. Twenty-three consecutive patients with prostate cancer treated by primary ADT were included. Imaging was performed at baseline and 3 months posttreatment with ADT. After 3 months therapy there was a significant reduction in all dynamic contrast-enhanced MRI parameters measured in tumor regions of interest (K trans , k ep , v p , IAUGC-90); P < 0.001. Areas of normal-appearing peripheral zone showed no significant change; P 5 0.285-0.879. Post-ADT, there was no significant change in apparent diffusion coefficient values in tumors, whilst apparent diffusion coefficient values significantly decreased in areas of normalappearing peripheral zone, from 1.786 3 10 23 mm 2 /s to 1.561 3 10 23 mm 2 /s; P 5 0.007. As expected the median ProstateSpecific Antigen (PSA) significantly reduced from 30 ng/mL to 1.5 ng/mL posttreatment, and median prostate volume dropped from 47.6 cm 3 to 24.9 cm 3 ; P < 0.001. These results suggest that dynamic contrast-enhanced MRI and diffusionweighted MRI offer different information but that both could prove useful adjuncts to the anatomical information provided by T2-weighted imaging. dynamic contrast-enhanced as a marker of angiogenesis may help demonstrate ADT resistance and diffusion-weighted imaging may be more accurate in determining presence of tumor cell death versus residual tumor. Magn Reson Med 67:778-785,

Prostate Cancer: assessing the effects of androgen-deprivation therapy using quantitative diffusion-weighted and dynamic contrast-enhanced MRI

“…This may be due to the known effect of ADT on the appearance of the prostate on T2-weighted MR images, which includes not only a shrinking of the prostate but also a diffuse decrease of signal intensity, rendering tumour delineation difficult when relying on T2-weighted images alone [4, 5]. So far, the value of multi-parametric MRI in this setting has scarcely been investigated, and only a few studies have examined the effect of ADT on functional MRI parameters [18–20]. …”

Diffusion-weighted MRI in early assessment of tumour response to radiotherapy in high-risk prostate cancer

“…26 Combination therapy with radiation and long-term ADT has been a standard of care for males with high-risk PC, demonstrating a significant survival benefit over radiotherapy alone. 27 Barrett et al 28 proved that there was no significant change in ADC values in tumours after 3 months of ADT, whereas ADC values significantly decreased in areas of the normal-appearing peripheral zone, from 1.78 3 10 23 to 1.56 3 10 23 mm 2 s 21 .…”

Intratumoral Heterogeneity of Breast Cancer Xenograft Models: Texture Analysis of Diffusion-Weighted MR Imaging

“…DW-MRI is an appealing imaging modality to examine tumor aggressiveness and responsiveness to therapy in the field of oncology because it can be easily incorporated into the clinical practice due to its non-invasiveness and quick acquisition time without contrast agents (32). Tumors with lower ADC values have been reported to correlate with higher cellularity, a tortuous extracellular space and a rapid tumor growth rate (33, 34). In an animal model, DW-MRI showed a higher sensitivity than T2-weighted MR images in the detection of colorectal liver metastasis (35).…”