Permanent prostate brachytherapy pubic arch evaluation with diagnostic magnetic resonance imaging

Abstract

Background/Purpose Pubic arch interference (PAI), when it occurs, is often a limiting factor for patients pursuing brachytherapy treatment of prostate cancer. Pre-brachytherapy pubic arch evaluation is often performed by CT or transrectal ultrasound (TRUS), but MRI has increasingly replaced these modalities for prostate cancer evaluation. The purpose of this study was to determine if staging MRI could be used to evaluate PAI and compare it to these other imaging methods. Methods Forty-one consecutive patients undergoing brachytherapy evaluation had pelvic MRI, CT, and TRUS based brachytherapy simulation. Pubic arch overlap on T2-weighted MRI and CT was determined by contouring the prostate gland on its largest axial slice and superimposing this contour onto the pubic arch bones. The largest degree of overlap of the prostate gland on MRI and CT was used to predict the existence of PAI as determined by TRUS based simulation. The correlation between prostate contour overlap was also compared between MRI and CT. Results Nineteen patients (48%) exhibited PAI on TRUS brachytherapy simulation evaluation. The average (± standard error) amount of prostate contour overlap on the pubic arch on CT was 2.9 ± 0.6 mm and on MRI was 2.0 ± 0.6 mm (linear correlation, R, of 0.783, p<0.001). CT and MRI were equally predictive of PAI on TRUS evaluation (AUC=0.75). Conclusion Pre-brachytherapy pubic arch assessment with diagnostic MRI provides similar predictability of PAI compared to CT, potentially obviating the need for additional pre-brachytherapy CT in the setting of staging MRI.

Predicting pubic arch interference in permanent prostate brachytherapy based on the specific parameters derived from nuclear magnetic resonance imaging

“…Pre-brachytherapy pubic arch evaluation is often performed by CT or TRUS. Using MRI to predict PAI is a new method [ 10 ].…”