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. 2022 Dec;12(12):5309-5325.
doi: 10.21037/qims-22-184.

Prediction of prostate cancer recurrence after radiation therapy using multiparametric magnetic resonance imaging and spectroscopy: assessment of prognostic factors on pretreatment imaging

Audrey Asuncion  1 , Paul Michael Walker  2   3 , Aurélie Bertaut  4 , Julie Blanc  4 , Maxime Labarre  5 , Etienne Martin  6 , Florian Bardet  7 , Jeremy Cassin  1 , Luc Cormier  7 , Gilles Crehange  8 , Romaric Loffroy  1   3 , Alexandre Cochet  2   3   9
Affiliations

Prediction of prostate cancer recurrence after radiation therapy using multiparametric magnetic resonance imaging and spectroscopy: assessment of prognostic factors on pretreatment imaging

Audrey Asuncion et al. Quant Imaging Med Surg. 2022 Dec.

Abstract

Background: To assess whether data from pre-therapeutic multiparametric magnetic resonance imaging (mpMRI) combined with three-dimensional magnetic resonance spectroscopy (3D MRS) provide prognostic factors of biochemical relapse in patients with localized prostate cancer treated by external radiotherapy or brachytherapy.

Methods: In our single institution observational retrospective study we included a cohort of 230 patients treated by external radiotherapy or brachytherapy who had an initial mpMRI with 3D MRS from January 2008 to December 2015 for newly diagnosed localized prostatic cancer, proven histologically. Three trained radiologists recorded tumor characteristics, MRI T-stage and metabolic abnormalities from 3D MRS data. Univariate and multivariate Cox analyzes explored the relationship between clinical and imaging variables to highlight prognostic factors for recurrence, using biochemical relapse as the primary endpoint.

Results: mpMRI data analysis allowed to reclassify 21.7% of the patients in a MRI National Comprehensive Cancer Network (NCCN) group higher than their initial clinical T-stage, but also to detect a lesion in 78% of the patients considered as clinically T1c. After a median of follow-up of 8.7 years (IQR, 6.6-10.1) following cancer diagnosis, 36 (16%) patients developed a biochemical relapse. The multivariate Cox analysis demonstrated the existence of 3 independent factors for prediction of biochemical recurrence: extracapsular extension (ECE) (HR =3.33; 95% CI: 1.93-5.73; P<0.01), choline/citrate ratio in healthy tissue in the transition zone (TZ) (HR =2.96; 95% CI: 1.06-8.28; P=0.04) and the NCCN Magnetic Resonance Imaging classification (intermediate versus low-risk, HR =3.06; 95% CI: 1.13-8.30; P<0.01).

Conclusions: Combination of mpMRI and 3DMRS could aid in the prognostic stratification of localized prostate cancer treated by radiotherapy or brachytherapy, by combining accurate evaluation of tumor extension, and quantification of prostate metabolism.

Keywords: Prostate; cancer; magnetic resonance imaging (MRI); radiotherapy; spectroscopy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-22-184/coif). RL serves as an unpaid Deputy Editor of Quantitative Imaging in Medicine and Surgery. AC serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Example of 3D MRS imaging. (A) The 3D MRS grid is positioned around the whole prostate on T2-weighted images. (B) Two voxels are seen here positioned on a T2-weighted image within normal PZ prostate tissue (red box) and PZ cancer tissue (yellow box). (C) Spectrum from normal PZ prostate and (D) spectrum from cancer tissue. The metabolites present in the spectra are Cho, Cr and Cit. 3D MRS, three-dimensional magnetic resonance spectroscopy; PZ, peripheral zone; Cho, choline; Cr, creatine; Cit, citrate.
Figure 2
Figure 2
Flow chart of the study. 3T, 3 Tesla; mpMRI, multiparametric magnetic resonance imaging; EBRT, external beam radiotherapy; BT, brachytherapy; NCCN, National Comprehensive Cancer Network.
Figure 3
Figure 3
Biochemical relapse-free survival.
See this image and copyright information in PMC

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