PI-RADS score is associated with biochemical control and distant metastasis in men with intermediate-risk and high-risk prostate cancer treated with radiation therapy

Turchan, William Tyler; Kauffmann, G. W.; Patel, Pritesh; Oto, A.; Liauw, Stanley L.

doi:10.1016/j.urolonc.2019.12.015

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…Similar findings were reported earlier concerning the prognostic value of the largest axial measurement of the index lesion [ 11 , 29 ] in patients treated with radiotherapy. The authors showed that the largest axial measurement, along with extraprostatic extension and seminal vesical invasion, are significantly associated with freedom from biochemical failure [ 29 ].…”

Section: Discussionsupporting

confidence: 91%

“…While there is overwhelming evidence of PI-RADS diagnostic value, there is a knowledge gap on its association with oncologic outcomes, especially in the context of radiation therapy. Only one study reported its prognostic value in patients treated with different schedules of primary RT [ 11 ]. In radiation therapy, PI-RADS could help to improve pre-treatment patient selection for tailored definitive therapy.…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

Miszczyk

Rembak-Szynkiewicz

Magrowski

et al. 2022

Cancers

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Prostate Imaging-Reporting and Data System (PI-RADS) has been widely implemented as a diagnostic tool for significant prostate cancer (PCa); less is known about its prognostic value, especially in the setting of primary radiotherapy. We aimed to analyze the association between PI-RADS v. 2.1 classification and risk of metastases, based on a group of 152 patients treated with ultra-hypofractionated stereotactic CyberKnife radiotherapy for localized low or intermediate risk-group prostate cancer. We found that all distant failures (n = 5) occurred in patients diagnosed with a PI-RADS score of 5, and axial measurements of the target lesion were associated with the risk of developing metastases (p < 0.001). The best risk stratification model (based on a combination of greatest dimension, the product of multiplication of PI-RADS target lesion axial measurements, and age) achieved a c-index of 0.903 (bootstrap-validated bias-corrected 95% CI: 0.848–0.901). This creates a hypothesis that PI-RADS 5 and the size of the target lesion are important prognostic factors in early-stage PCa patients and should be considered as an adverse prognostic measure for patients undergoing early treatment such as radiation or focal therapy.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

Miszczyk

Rembak-Szynkiewicz

Magrowski

et al. 2022

Cancers

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“…In the PI-RADS era, smaller studies with standardized reporting have examined this question yet each, on their own, appears insufficient to draw broader conclusions. 22–30…”

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confidence: 99%

The Prognostic Association of Prostate MRI PI-RADS™ v2 Assessment Category and Risk of Biochemical Recurrence after Definitive Local Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis

et al. 2021

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Study Need and Importance: Despite the wide acceptance of Prostate ImagingeReporting and Data System version 2 (PI-RADS v2) as a reporting system for prostate magnetic resonance imaging (MRI), less is known about its prognostic significance. This study aimed to synthesize the evidence concerning the association between PI-RADS v2 and the risk of biochemical recurrence (BCR) after primary definitive therapy of prostate cancer. What We Found: Out of 9 included studies 8 were conducted in the context of radical prostatectomy and 1 post-radiation. Higher PI-RADS v2 scores were consistently associated with BCR after definitive treatment with pooled HR of 3.19 (95% CI 2.28e4.45; p <0.01) Limitations: Included studies were retrospective and unblinded in nature, potentially contributing biases in terms of treatment selection and surveillance. Furthermore, PI-RADS v2 was analyzed as continuous and categorized variables with various cut-offs, which were chosen based on data availability, study design, and statistical methods. In

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“…Two studies proposed the usage of diffusion-weighted MRI as an imaging biomarker for monitoring response of PCa to primary RT (36,37). Turchan et al showed that PCa lesions with PI-RADs score of 5 increase the risk of failure after RT for primary PCa (38).…”

Section: Discussionmentioning

confidence: 99%

Predicting Biochemical Failure in Irradiated Patients With Prostate Cancer by Tumour Volume Measured by Multiparametric MRI

Oerther

Büren

Klein

et al. 2020

In Vivo

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Background/Aim: We examined the prognostic value of intraprostatic gross tumour volume (GTV) as measured by multiparametric MRI (mpMRI) in patients with prostate cancer following (primary) external beam radiation therapy (EBRT). Patients and Methods: In a retrospective monocentric study, we analysed patients with prostate cancer (PCa) after EBRT. GTV was delineated in pre-treatment mpMRI (GTV-MRI) using T2-weighted images. Coxregression analyses were performed considering biochemical failure recurrence-free survival (BRFS) as outcome variable. Results: Among 131 patients, after a median follow-up of 57 months, biochemical failure occurred in 27 (21%). GTV-MRI was not correlated with % of positive biopsy cores, Gleason score and initial PSA (all r<0.2) and only moderately correlated with cT stage (r=0.32). In univariate analysis, cT stage, Gleason score and GTV-MRI were higher in subjects with shorter BRFS (p<0.05). GTV-MRI remained a significant predictor for BRFS in multivariate analyses, independent of Gleason score and cT stage. Conclusion: GTV, defined using mpMRI, provides incremental prognostic value for BRFS, independent of established risk factors. This supports the implementation of imaging-based GTV for riskstratification, although further validation is needed.For patients with primary prostate cancer (PCa), an accurate risk stratification is mandatory to select a suitable treatment. The National Comprehensive Cancer Network riskclassification system for primary PCa patients lists clinical T stage (cT stage), Gleason score, the percentage of positive biopsy cores (PPBC) and initial prostate-specific antigen (iPSA) levels as important factors (1). Each has been shown to be an independent risk factor of biochemical failure after definitive radiotherapy (RT) (2). However, this model does not always predict the final outcome and its predictions may be very heterogeneous (3). Consequently, more robust riskfactors are urgently needed.The implementation of multiparametric magnetic resonance imaging (mpMRI) shows promising results in the delineation of the intraprostatic gross tumour volume (GTV) and is considered as the standard of care diagnostic imaging modality for patients with primary PCa (1). Three studies examined whether local recurrences of PCa after primary RT occur at the location of the primary lesion using pre-and post-treatment MRI in a limited number of patients. Each 3473 This article is freely accessible online.

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PI-RADS score is associated with biochemical control and distant metastasis in men with intermediate-risk and high-risk prostate cancer treated with radiation therapy

Cited by 16 publications

References 19 publications

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

The Prognostic Value of PI-RADS Score in CyberKnife Ultra-Hypofractionated Radiotherapy for Localized Prostate Cancer

The Prognostic Association of Prostate MRI PI-RADS™ v2 Assessment Category and Risk of Biochemical Recurrence after Definitive Local Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis

Predicting Biochemical Failure in Irradiated Patients With Prostate Cancer by Tumour Volume Measured by Multiparametric MRI

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