Detection of Recurrent Prostate Cancer after Primary Radiation Therapy: an Evaluation of the Role of Multiparametric 3T MRI imaging with Endorectal Coil

Publication date: Available online 14 June 2016
Source:Practical Radiation Oncology
Author(s): Fabio Zattoni, Akira Kawashima, Alessandro Morlacco, Brian J. Davis, Avinash Nehra, Lance Mynderse, Adam Froemming, R. Jeffrey Karnes
ObjectiveThe value of multiparametric MRI (mpMRI) in staging prostate cancer (PCa) prior to salvage prostatectomy (sRP) is currently unclear, due to minimal data comparing mpMRI results to final pathologic stage at surgery. The aim of the study is to determine the diagnostic performance of mpMRI in characterizing viable recurrent tumor and lymph node metastasis following radiation therapy (RT) failure.MethodsBetween 01/2007-07/2014, nineteen patients with biopsy proven recurrent PCa after primary RT underwent 3 Tesla mpMRI and subsequent sRP with extended pelvic lymphadenectomy. mpMRI images were independently reviewed by two GU MRI radiologists (R1 and R2), blinded to the pathology results, to evaluate extraprostatic extension (EPE), seminal vesicle invasion (SVI), and pelvic lymph node metastasis (PLNM). Sensitivity, specificity, PPV, NPV, ROC curves and interobserver agreement (R1 and R2) were evaluated for each outcome on a per-patient basis. Final pathologic results were used as a gold standard for comparison in all patients. A multivariate analysis was conducted to assess the relationship between the index lesion's ADC value and its enhancement characteristics with the Gleason Score.ResultsEPE was found in 14 (73.7%) patients, SVI in 13 (68.4%), and PLNM in 5 (26.3%). mpMRI sensitivity for PLNM was 60.0 % (R1 &R2) with specificity of 85.7 % (R1) and 92.8 % (R2). With regards to SVI, the sensitivity was 61.5 % (R1) and 76.9 % (R2) with specificity of 66.6 % (R1 and R2). Sensitivity for EPE was 50.0% (R1) and 71.43% (R2) with specificity of 80.0%(R1) and 100.00 %(R2).No significant associations were found at multivariate analysis. The evaluation of PLNM, SVI, and PCa recurrence within the prostate demonstrated moderate interobserver agreement (k: 0.51–0.57).ConclusionsmpMRI has good accuracy for detecting PLNM, SVI and ECE after RT. MpMRI provides useful information in locally-recurrent PCa following primary radiotherapy.



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