Multiparametric MRI as a Biomarker of Response to Neoadjuvant Therapy for Localized Prostate Cancer-A Pilot Study.
Acad Radiol
; 27(10): 1432-1439, 2020 10.
Article
in En
| MEDLINE
| ID: mdl-31862185
ABSTRACT
RATIONALE AND OBJECTIVES:
To explore a role for multiparametric MRI (mpMRI) as a biomarker of response to neoadjuvant androgen deprivation therapy (ADT) for prostate cancer (PCa). MATERIALS ANDMETHODS:
This prospective study was approved by the institutional review board and was HIPAA compliant. Eight patients with localized PCa had a baseline mpMRI, repeated after 6-months of ADT, followed by prostatectomy. mpMRI indices were extracted from tumor and normal regions of interest (TROI/NROI). Residual cancer burden (RCB) was measured on mpMRI and on the prostatectomy specimen. Paired t-tests compared TROI/NROI mpMRI indices and pre/post-treatment TROI mpMRI indices. Spearman's rank tested for correlations between MRI/pathology-based RCB, and between pathological RCB and mpMRI indices.RESULTS:
At baseline, TROI apparent diffusion coefficient (ADC) was lower and dynamic contrast enhanced (DCE) metrics were higher, compared to NROI (ADC 806 ± 137â¯×â¯10-6 vs. 1277 ± 213â¯×â¯10-6 mm2/sec, pâ¯=â¯0.0005; Ktrans 0.346 ± 0.16 vs. 0.144 ± 0.06 min-1, pâ¯=â¯0.002; AUC90 0.213 ± 0.08 vs. 0.11 ± 0.03, pâ¯=â¯0.002). Post-treatment, there was no change in TROI ADC, but a decrease in TROI Ktrans (0.346 ± 0.16 to 0.188 ± 0.08 min-1; pâ¯=â¯0.02) and AUC90 (0.213 ± 0.08 to 0.13 ± 0.06; pâ¯=â¯0.02). Tumor volume decreased with ADT. There was no difference between mpMRI-based and pathology-based RCB, which positively correlated (â´â¯=â¯0.74-0.81, p < 0.05). Pathology-based RCB positively correlated with post-treatment DCE metrics (â´â¯=â¯0.76-0.70, p < 0.05) and negatively with ADC (â´ = -0.79, pâ¯=â¯0.03).CONCLUSION:
Given the heterogeneity of PCa, an individualized approach to ADT may maximize potential benefit. This pilot study suggests that mpMRI may serve as a biomarker of ADT response and as a surrogate for RCB at prostatectomy.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Prostatic Neoplasms
/
Neoadjuvant Therapy
Type of study:
Observational_studies
Limits:
Humans
/
Male
Language:
En
Journal:
Acad Radiol
Journal subject:
RADIOLOGIA
Year:
2020
Type:
Article