Abstract
PurposeAccurate prostate cancer (PCa) detection is essential for planning focal external beam radiotherapy (EBRT). While biparametric MRI (bpMRI) including T2-weighted (T2w) and diffusion-weighted images (DWI) is an accurate tool to localize PCa, its value is less clear in the case of additional androgen deprivation therapy (ADT). The aim of this study was to investigate the value of a textural feature (TF) approach on bpMRI analysis in prostate cancer patients with and without neoadjuvant ADT with respect to future dose-painting applications.Methods28 PCa patients (54–80 years) with (n = 14) and without (n = 14) ADT who underwent bpMRI with T2w and DWI were analyzed retrospectively. Lesions, central gland (CG), and peripheral zone (PZ) were delineated by an experienced urogenital radiologist based on localized pre-therapeutic histopathology. Histogram parameters and 20 Haralick TF were calculated. Regional differences (i. e., tumor vs. PZ, tumor vs. CG) were analyzed for all imaging parameters. Receiver-operating characteristic (ROC) analysis was performed to measure diagnostic performance to distinguish PCa from benign prostate tissue and to identify the features with best discriminative power in both patient groups.ResultsThe obtained sensitivities were equivalent or superior when utilizing the TF in the no-ADT group, while specificity was higher for the histogram parameters. However, in the ADT group, TF outperformed the conventional histogram parameters in both specificity and sensitivity. Rule-in and rule-out criteria for ADT patients could exclusively be defined with the aid of TF.ConclusionsThe TF approach has the potential for quantitative image-assisted boost volume delineation in PCa patients even if they are undergoing neoadjuvant ADT.
Highlights
Defining boost volumes for prostate cancer (PCa) patients is a major step towards personalized radiation oncology with the overall goal of increasing tumor control probability
No significant differences were found between the androgen deprivation therapy (ADT) and no-ADT patient groups for PSAinitial, region of interest (ROI) volumes, and Gleason scores (GS)
Trends (p < 0.05) to lower values in the ADT group could be observed for mean, standard deviation (SD), and 95perc of apparent diffusion coefficient (ADC) of the central gland (CG) and T2w kurtosis of the focal lesion
Summary
Defining boost volumes for prostate cancer (PCa) patients is a major step towards personalized radiation oncology with the overall goal of increasing tumor control probability. Several other studies investigated the feasibility of boosting the dominant intraprostatic lesion with various methods in patients with advanced prostate cancer, which indicated superior local control [3,4,5,6,7]. The presented results suggest that the implementation of this approach in intermediate and highrisk prostate cancer patients improves tumor control while keeping side effects at a reasonable level. Some groups based the delineation of the boost volume on PET imaging [4, 5], multiparametric (mp) magnetic resonance imaging (MRI) has become the preferred method for this purpose [8, 9]. For the external beam radiotherapy (EBRT) planning in prostate cancer it is recommended to base prostate gland delineation on MRI [11, 12]
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