Tumor staging using 3.0 T multiparametric MRI in prostate cancer: impact on treatment decisions for radical radiotherapy.

To assess and validate the incorporation of the multiparametric magnetic resonance imaging (mpMRI) tumour category (mT-category) to the conventional clinical tumour category (cT-category), in order to guide the radiotherapy (RT) treatment decisions in prostate cancer.

In addition, to identify the clinical factors associated to the technique reliability. mpMRI was performed in 274 prostate cancer patients in order to refine the treatment decisions according to PSA, Gleason Score (GS) and cT-category. Comparisons between the cT and mT-category were performed, as well as the impact on the RT treatment [target volume, doses and hormonal therapy (HT)] independently if it was finally performed. Changes in HT indication for intermediate risk were also analyzed. mpMRI validation was performed with pathological staging (n = 90 patients finally decided to join surgery). The mpMRI upstaging range was 86-94 % for any PSA value or GS. Following mpMRI, 32. 8 % of the patients (90/274) were assigned to a different risk group. Compared to cT-category, mpMRI identified more intermediate-risk (46. 4 vs. 59. 5 %) and high-risk (19. 0 vs. 28. 8 %) prostate cancer patients. This resulted in a higher indication (p < 0. 05) of seminal vesicle irradiation (63. 5 vs. 70. 0 %), inclusion of any extracapsular disease (T3-T4) within the target volume (1. 8 vs. 18. 2 %), higher doses (65. 3 vs. 88. 3 %) and HT associated to RT (45. 6 vs. 62. 4 %). Global accuracy for mpMRI was higher compared to DRE/TRUS (8. 9 vs. 71. 1 %, p < 0. 05). mpMRI reliability was independent of PSA or GS. mpMRI tumor staging significantly modified the RT treatment decisions in all prostate cancer risk groups.

SpringerPlus. 2015 Dec 18*** epublish ***

Felipe Couñago, Elia Del Cerro, Ana Aurora Díaz-Gavela, Francisco José Marcos, Manuel Recio, David Sanz-Rosa, Israel Thuissard, Karmele Olaciregui, María Mateo, Laura Cerezo

Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain. , Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain. , Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain. , Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain. , Department of Radiology, Hospital Universitario Quiron, Madrid, Spain. , Clinical Department, School of Biomedical Sciences, Universidad Europea, Madrid, Spain. , School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain. , School of Biomedical Sciences, Universidad Europea, Madrid, Spain. , Hospital Universitario Quiron, Madrid, Spain. , Departament of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain.

PubMed      Full Text Article

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