Prostate MRSI predicts outcome in radical prostatectomy patients

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• 作者：Kristen L. Zakian^a ; ^{zakiank@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; William Hatfield^b ; ^{wnhat1@student.monash.edu" class="auth_mail" title="E-mail the corresponding author} ; Omer Aras^b ; ^{araso@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Kun Cao^b ; ^{kun-cao@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Derya Yakar^b ; ^{derya.yakar@radboudumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Debra A. Goldman^b ; ^{goldmand@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Chaya S. Moskowitz^b ; ^{moskowc1@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Amita Shukla-Dave^b ; ^{davea@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Yousef Mazaheri Tehrani^b ; ^{mazahery@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Samson Fine^b ; ^{fines@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; James Eastham^b ; ^{easthamj@mskcc.org" class="auth_mail" title="E-mail the corresponding author} ; Hedvig Hricak^b ; ^{hricakh@mskcc.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BCR ; biochemical recurrence ; CC/C ; ratio of total choline plus creatine to citrate ; CRS ; clinical risk score ; DW-MRI ; diffusion-weighted MRI ; ECE ; extracapsular extension ; MRSI ; magnetic resonance spectroscopic imaging ; NCCN ; National Comprehensive Care Network ; NHGV ; number of high-grade voxels ; NILV ; number of index lesion voxels ; NPC ; number of positive biopsy core ; NUPV ; number of voxels with undetectable polyamines ; PA ; polyamines ; PCa ; prostate cancer ; PSA ; prostate-specific antigen ; RP ; r
• 刊名：Magnetic Resonance Imaging
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：34
• 期：5
• 页码：674-681
• 全文大小：568 K

文摘

New non-invasive methods are needed for sub-stratifying high-risk prostate cancer patients. Magnetic resonance spectroscopic imaging (MRSI) maps metabolites in prostate cancer, providing information on tumor aggressiveness and volume.

Purpose

To investigate the correlation between MRSI and treatment failure (TF) after radical prostatectomy (RP).

Methods

Two-hundred sixty-two patients who underwent endorectal MRI/MRSI followed by RP at our institution from 2003 to 2007 were studied. MRI stage, number of voxels in the MRSI index lesion (NILV), number of high-grade voxels (NHGV), and number of voxels containing undetectable polyamines (NUPV) were derived. Clinical outcome was followed until August, 2014. Treatment failure was defined as 1) biochemical recurrence (BCR), 2) persistently detectable PSA after RP, or 3) adjuvant therapy initiated in the absence of BCR. MRI/MRSI features and clinical parameters were compared to TF by univariate Cox Proportional Hazards Regression. After backward selection, each MRSI parameter was included in a separate regression model adjusted for NCCN-based clinical risk score (CRS), number of biopsy cores positive (NPC), and MRI stage.

Results

In univariate analysis, all clinical variables were associated with TF in addition to MRI stage, NILV, NHGV, and NUPV. In multivariate analysis, NILV, NHGV, and NUPV were also significant risk factors for TF (p = 0.016, p = 0.002, p = 0.006, respectively). The association between the number of tumor voxels with undetectable polyamines and the probability of treatment failure has not been previously reported. The number of MRSI cancer voxels correlated with extracapsular extension (ECE) (p < 0.0001).

Conclusions

MRSI was associated with post-radical prostatectomy treatment failure in models adjusted for the number of positive biopsy cores and clinical risk score. This is the first report that in radical prostatectomy patients MRSI has an association with treatment failure independent of the number of positive biopsy cores. MRSI may help the clinician determine whether patients with high risk disease who undergo RP are candidates for specialized additional treatment.