Role of 3T multiparametric magnetic resonance imaging without endorectal coil in the detection of local recurrent prostate cancer after radical prostatectomy: the radiation oncology point of view

Couñago, Felipe; Cerro, Elia del; Recio, Manuel; Díaz, Ana Patricia Ovejero; Marcos, Francisco José; Cerezo, Laura; Maldonado, Antonio; Rodriguez-Luna, J.M.; Thuissard, Israel; Martín, Juan Antonio González

doi:10.3109/21681805.2015.1004643

Cited by 16 publications

(12 citation statements)

References 28 publications

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“…Several factors, including PSA levels at recurrence, the PSADT, and the presence of compromised resection margins, have all been significantly associated with mpMRI findings. Several authors have defined pre-radiotherapy PSA cut-off values, ranging from > 0.3[ 37 ] to > 0.5[ 40 ] or ≥ 0.54[ 39 ] ng/mL, as clinical predictors of MRI positivity. Eifler et al[ 19 ] reported a higher probability of visible local relapse in patients with PSADT > 14 mo.…”

Section: Detection Of Relapse After Radical Prostatectomymentioning

confidence: 99%

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know

Couñago¹,

Sancho²,

Catalá³

et al. 2017

WJCO

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External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.

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Section: Detection Of Relapse After Radical Prostatectomymentioning

confidence: 99%

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know

Couñago¹,

Sancho²,

Catalá³

et al. 2017

WJCO

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“…Thus, after RP, the optimal PSA cut-off level for choline PET/CT analysis seems to be between 1 and 2 ng/mL [23], while for MRI, the corresponding value appears to range from 0.3 to 0.54 ng/mL [5]. In addition to the PSA value, several studies have reported that PSA kinetics (PSADT, PSA velocity) are strong predictors for positive PET and MRI findings, even in patients with low PSA values [4, 5, 23]. We found that PSADT was significantly associated with the type of pelvic recurrence: patients with a higher PSADT had an increased probability of local recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Fifth, we did not use endorectal coil and this may have influenced the reliability of the MRI images [26]. Nevertheless, in patients with tumor recurrence after RP, the tumor detection rate using a 3T MRI seems not to be influenced by the type of coil [4]. Lastly, in our study 4 patients received ADT before MRI and PET/CT, which could have a limited uptake on the choline PET/CT and caused morphological changes and alterations in the parameters of the DWI and DCE on the MRI [27, 28].…”

Section: Discussionmentioning

confidence: 99%

“…Multiparametric MRI has proven useful in the detection of LR in the prostate gland, even in patients with low prostate-specific antigen (PSA) levels (<0.5 ng/mL) [4], although few studies have assessed the value of mpMRI to LNR or pelvic bone BM [2, 5]. By contrast, 18F-CH PET/CT has proven effective in detecting LNR and BM after RP, primarily in patients with PSA >1 ng/mL or with PSA doubling time (PSADT) < 6 months [6].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of tumor recurrences after radical prostatectomy using 18F-Choline PET/CT and 3T multiparametric MRI without endorectal coil: a single center experience

et al. 2016

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BackgroundTo evaluate and compare the utility of 18F-fluorocholine (18F-CH) PET/CT versus 3-Tesla multiparametric MRI (mpMRI) without endorectal coil to detect tumor recurrences in patients with biochemical relapse following radical prostatectomy (RP). Secondarily, to identify possible prognostic variables associated with mpMRI and 18F-CH PET/CT findings.MethodsRetrospective study of 38 patients who developed biochemical recurrence after RP between the years 2011 and 2015 at our institution. PET/CT and mpMRI were both performed within 30 days of each other in all patients. The PET/CT was reviewed by a nuclear medicine specialist while the mpMRI was assessed by a radiologist, both of whom were blinded to outcomes.ResultsThe median prostate-specific antigen (PSA) value pre-MRI/PET-CT was 0.9 ng/mL (interquartile range 0.4–2.2 ng/mL). There were no differences in the detection rate between 18F-CH PET/CT and mpMRI for local recurrence (LR), lymph node recurrence (LNR) and bone metastases (BM). Separately, mpMRI and 18F-CH PET/CT were positive for recurrence in 55.2% and 52.6% of cases, respectively, and in 65.7% of cases when findings from both modalities were considered together. The detection of LR was better with combined mpMRI and choline PET/CT versus choline PET/CT alone (34.2% vs 18.4%, p = 0.04). Salvage treatment was modified in 22 patients (57.8%) based on the imaging findings. PSA values on the day of biochemical failure were significantly associated with mpMRI positivity (adjusted odds ratio (OR): 30.9; 95% confidence interval (CI): 1.5–635.8). Gleason score > 7 was significantly associated with PET/CT positivity (OR: 13.9; 95% CI: 1.5–125.6). A significant association was found between PSA doubling time (PSADT) (OR: 1.3; 95% CI: 1.0–1.7), T stage (OR: 21.1; 95% CI: 1.6–272.1), and LR.ConclusionsMultiparametric MRI and 18F-CH PET/CT yield similar detection rates for LR, LNR and pelvic BM. The combination of both imaging techniques provides a better LR detection versus choline PET/CT alone. The initially planned salvage treatment was modified in 57.8% of patients due to imaging findings. In addition to PSA values, Gleason score, T stage, and PSADT may provide valuable data to identify those patients that are most likely to benefit from undergoing both imaging procedures.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0099-8) contains supplementary material, which is available to authorized users.

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“… 55 This has been further supported by a recent trial using 3 T MRI without EC, which showed that the probability of radiographic local recurrence was significantly higher in patients with PSA >0.5 ng/mL. 56 However, these are retrospective studies, and no histopathological confirmation was undertaken to confirm the interpretation of the mp-MRI findings. Additionally, to our knowledge, there are no comparative studies evaluating the value of increasing the field strength of the magnet and using an EC in detecting local recurrence.…”

Section: Use Of Multi-parametric Mri In Ctv Delineationmentioning

confidence: 96%

Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

Murray

McNair

Dearnaley

2015

CMAR

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The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion.

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Role of 3T multiparametric magnetic resonance imaging without endorectal coil in the detection of local recurrent prostate cancer after radical prostatectomy: the radiation oncology point of view

Abstract: This is the first study to find a significant relationship between the PSADT and the rLR through MRI. Patients with PSADT longer than 14 months or pre-SRT PSA above 0.5 ng/ml benefited most from 3TmMRI. Its routine use could have significant clinical implications for SRT.

Cited by 16 publications

References 28 publications

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know

Evaluation of tumor recurrences after radical prostatectomy using 18F-Choline PET/CT and 3T multiparametric MRI without endorectal coil: a single center experience

Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

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