Prognostic Value of Pretreatment MRI in Patients With Prostate Cancer Treated With Radiation Therapy: A Systematic Review and Meta-Analysis.

OBJECTIVE. Despite a substantial increase in the use of MRI for pretreatment evaluation of prostate cancer, its prognostic value in patients undergoing radiation therapy (RT) is not well known. Therefore, the purpose of this study was to systematically review the literature and perform a meta-analysis on the prognostic value of pretreatment MRI in patients with prostate cancer who underwent external beam radiation therapy (EBRT) or brachytherapy. MATERIALS AND METHODS. PubMed and Embase databases were searched for studies published on or before March 13, 2019. We included studies that evaluated pretreatment MRI as a prognostic factor in prostate cancer regarding biochemical recurrence (BCR), metastatic failure, and overall or cancer-specific mortality. Effect sizes were measured in terms of the hazard ratio (HR) and were meta-analytically pooled using the random-effects model. The quality of the studies was independently evaluated using the Quality in Prognostic Studies tool. RESULTS. Twelve studies (2205 patients) were included. All studies assessed BCR; metastasis was evaluated in three studies, and mortality was evaluated in one study. Extraprostatic extension (EPE), seminal vesicle invasion (SVI), large tumor size or volume, number of sextants involved, and tumor involvement of prostatic apex were significant prognostic factors of BCR (pooled HRs = 1.50-4.47). EPE, larger tumor size, greater tumor volume, presence of metastatic pelvic lymph nodes (LNs), and presence of SVI were significant risk factors for metastasis (pooled HRs = 1.12-11.96). Pelvic LN metastasis was significantly predictive of cancer-specific mortality (HR = 4.45 [95% CI, 1.30-15.23]). CONCLUSION. Several pretreatment MRI findings were significant prognostic factors in patients with prostate cancer who underwent RT.

AJR. American journal of roentgenology. 2019 Dec 04 [Epub ahead of print]

Sungmin Woo, Sangwon Han, Tae-Hyung Kim, Chong Hyun Suh, Antonio C Westphalen, Hedvig Hricak, Michael J Zelefsky, Hebert Alberto Vargas

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065., Department of Nuclear Medicine, Armed Forces Daejeon Hospital, Daejeon, Korea., Department of Radiology, Naval Pohang Hospital, Pohang, Korea., Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea., Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.