Predicting biochemical recurrence in patients with high-risk prostate cancer using the apparent diffusion coefficient of magnetic resonance imaging

Abstract

PurposeWe aimed to investigate whether the apparent diffusion coefficient (ADC) value in diffusion-weighted magnetic resonance imaging predicts the prognoses of patients with high-risk prostate cancer.Materials and MethodsA total of 157 patients with high-risk prostate cancer (based on D'Amico's criteria) were included in the analysis. Patients underwent preoperative 3.0 Tesla magnetic resonance imaging within 2 months before radical prostatectomy. Those who received neoadjuvant hormone therapy (33 persons) or radiation therapy (18 persons) were excluded. The ADC of the tumor calculated from 2 b-values (0 and 1,000 s/mm2) was measured. Areas under receiver operating characteristics curves were calculated to maximize the accuracy of the ADC value. Based on the obtained cutoff value, the patients were stratified into 2 groups: Group A consisted of patients with ADC values <746×10−6 mm2/s and group B comprised those with ADC values ≥746×10−6 mm2/s.ResultsGroup A showed higher rate of lymph positive and biochemical recurrence (BCR) rates than group B. Kaplan-Meier analysis showed that the BCR-free survival rate of group A was much lower than that of group B (p<0.001). On Cox proportional regression analyses, ADC group A (hazard ratio [HR], 3.238, p=0.002) and pathologic lymph node positive (HR, 2.242; p=0.009) were independent predictors of BCR.ConclusionsIn patients with high-risk prostate cancer, ADC value is significantly associated with BCR-free survival. Therefore, the ADC value is a useful tool for predicting the prognoses of these high-risk patients.

Multiparametric MRI Apparent Diffusion Coefficient (ADC) Accuracy in Diagnosing Clinically Significant Prostate Cancer

“…Recently, Kim et al (2) reported a mean ADC value for disease with a GS of 7 equal to 0.741±0.164×10 -3 mm 2 /s; moreover, Salami et al (16) showed that larger prostate cancers were associated with lower ADC values. Finally, Yoon et al (17) and Kido et al (18) demonstrated that ADC was significantly associated with biochemical-free recurrence and extracapsular PCa extension, respectively.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], clinical stage T1c and median GS equal to 6.8 (range=6-9) underwent radical retropubic prostatectomy (RRP) for biopsy of clinically significant PCa (GS ≥6 and/or more than 2 positive cores and/or a greatest percentage of cancer for each core >50%) (10); 16/44 (36.6%) patients previously enrolled in Active Surveillance (AS) program were upgraded at confirmatory biopsy and 28/44 (63.4%) men underwent repeat saturation biopsy (median=30 cores; range=28-34 cores) for persistent suspicious cancer. Previously, all patients about 10 days before prostate biopsy underwent pelvic mpMRI and two radiologists blinded to pre-imaging clinical parameters evaluated the mpMRI data separately and independently.…”

Optimising preoperative risk stratification tools for prostate cancer using mpMRI

“…(iv) Differences between scanners and imaging techniques will probably result in slightly different cut-off points, presumably in a similar range around 650, 800 and 950 mm 2 /s. However, Yoon et al [ 19 ] dichotomised at the ADC level of 746 mm 2 /s. The differences in ADC cut-off from our study were most probably due to differences in scanner, b values and their high-risk patient cohort.…”

“…During the last decade, multiparametric MRI (mpMRI) of the prostate was introduced for detection and localisation of PCa. Recent studies indicate that mpMRI has a high diagnostic accuracy for detection of PCa [ 12 , 13 ], can improve predictions of preoperative clinical nomograms, at least for locally advanced disease [ 14 , 15 ], and that mpMRI may both improve predictions of clinical BCR nomograms [ 16 – 19 ] and improve risk stratification for detection of significant PCa [ 20 ].…”

How rapid advances in imaging are defining the future of precision radiation oncology

“…A change in tumour cellularity, perfusion and cellular necrosis following treatment is reflected in a change in the ADC value, and the potential utility of DWI in tumour detection, grading and assessment of treatment response has been demonstrated in a range of tumour types. 39 , 40 ADC values have been assessed in patients with HNSCC treated with chemoradiation. Significantly lower pre-treatment ADC values were found in complete responders when compared to partial responders, suggesting that this biomarker could be used to predict response to treatment and may even allow for dose-modification.…”