mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy.

Using multiparametric magnetic resonance imaging (mpMRI), we sought to preoperatively characterize prostate cancer (PCa) in the setting of antiandrogen plus androgen deprivation therapy (AA-ADT) prior to robotic-assisted radical prostatectomy (RARP). We present our preliminary findings regarding mpMRI depiction of changes of disease staging features and lesion appearance in treated prostate.

Prior to RARP, men received 6 months of enzalutamide and goserelin. mpMRI consisting of T2 weighted, b = 2,000 diffusion weighted imaging, apparent diffusion coefficient mapping, and dynamic contrast enhancement sequences was acquired before and after neoadjuvant therapy. Custom MRI-based prostate molds were printed to directly compare mpMRI findings to H&E whole-mount pathology as part of a phase II clinical trial (NCT02430480).

Twenty men underwent imaging and RARP after a regimen of AA-ADT. Positive predictive values for post-AA-ADT mpMRI diagnosis of extraprostatic extension, seminal vesicle invasion, organ-confined disease, and biopsy-confirmed PCa lesions were 71%, 80%, 80%, and 85%, respectively. Post-treatment mpMRI correctly staged disease in 15/20 (75%) cases with 17/20 (85%) correctly identified as organ-confined or not. Of those incorrectly staged, 2 were falsely positive for higher stage features and 1 was falsely negative. Post-AA-ADT T2 weighted sequences best depicted presence of PCa lesions as compared to diffusion weighted imaging and dynamic contrast enhancement sequences.

mpMRI proved reliable in detecting lesion changes after antiandrogen therapy corresponding to PCa pathology. Therefore, mpMRI of treated prostates may be helpful for assessing men for surgical planning and staging.

Urologic oncology. 2019 Apr 15 [Epub ahead of print]

Samuel A Gold, David J VanderWeele, Stephanie Harmon, Jonathan B Bloom, Fatima Karzai, Graham R Hale, Shawn Marhamati, Kareem N Rayn, Sherif Mehralivand, Maria J Merino, James L Gulley, Marijo Bilusic, Ravi A Madan, Peter L Choyke, Baris Turkbey, William Dahut, Peter A Pinto

Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD., Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD., Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, Georgetown University Hospital, Washington, DC., Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD., Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD., Laboratory for Genitourinary Cancer Pathogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: .