Guidance of treatment decisions in risk-adapted primary radiotherapy for prostate cancer using multiparametric magnetic resonance imaging: a single center experience

Radiation Oncology

Ludwig Plasswilm²  Daniel M Aebersold³  Sarah Haile⁴  Suk-kyum Kim¹  Paul Martin Putora²  Thierry Panje²  Cedric Panje² 

[1] Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland;Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland;Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland;Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland

关键词: Radiotherapy;    Prostate cancer;    Multiparametric;    MRI;   

Others  :  1149576
DOI  :  10.1186/s13014-015-0338-3

 received in 2014-11-26, accepted in 2015-01-21,  发布年份 2015

【 摘 要 】

Background

Magnetic resonance imaging (MRI) of the prostate is considered to be the most precise noninvasive staging modality for localized prostate cancer. Multiparametric MRI (mpMRI) dynamic sequences have recently been shown to further increase the accuracy of staging relative to morphological imaging alone. Correct radiological staging, particularly the detection of extraprostatic disease extension, is of paramount importance for target volume definition and dose prescription in highly-conformal curative radiotherapy (RT); in addition, it may affect the risk-adapted duration of additional antihormonal therapy. The purpose of our study was to analyze the impact of mpMRI-based tumor staging in patients undergoing primary RT for prostate cancer.

Methods

A total of 122 patients admitted for primary RT for prostate cancer were retrospectively analyzed regarding initial clinical and computed tomography-based staging in comparison with mpMRI staging. Both tumor stage shifts and overall risk group shifts, including prostate-specific antigen (PSA) level and the Gleason score, were assessed. Potential risk factors for upstaging were tested in a multivariate analysis. Finally, the impact of mpMRI-based staging shift on prostate RT and antihormonal therapy was evaluated.

Results

Overall, tumor stage shift occurred in 55.7% of patients after mpMRI. Upstaging was most prominent in patients showing high-risk serum PSA levels (73%), but was also substantial in patients presenting with low-risk PSA levels (50%) and low-risk Gleason scores (45.2%). Risk group changes occurred in 28.7% of the patients with consequent treatment adaptations regarding target volume delineation and duration of androgen deprivation therapy. High PSA levels were found to be a significant risk factor for tumor upstaging and newly diagnosed seminal vesicle infiltration assessed using mpMRI.

Conclusions

Our findings suggest that mpMRI of the prostate leads to substantial tumor upstaging, and can considerably affect treatment decisions in all patient groups undergoing risk-adapted curative RT for prostate cancer.

【 授权许可】

   
2015 Panje et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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