Abstract
To assess and validate the incorporation of the multiparametric magnetic resonance imaging (mpMRI) tumour category (mT-category) to the conventional clinical tumour category (cT-category), in order to guide the radiotherapy (RT) treatment decisions in prostate cancer. In addition, to identify the clinical factors associated to the technique reliability. mpMRI was performed in 274 prostate cancer patients in order to refine the treatment decisions according to PSA, Gleason Score (GS) and cT-category. Comparisons between the cT and mT-category were performed, as well as the impact on the RT treatment [target volume, doses and hormonal therapy (HT)] independently if it was finally performed. Changes in HT indication for intermediate risk were also analyzed. mpMRI validation was performed with pathological staging (n = 90 patients finally decided to join surgery). The mpMRI upstaging range was 86–94 % for any PSA value or GS. Following mpMRI, 32.8 % of the patients (90/274) were assigned to a different risk group. Compared to cT-category, mpMRI identified more intermediate-risk (46.4 vs. 59.5 %) and high-risk (19.0 vs. 28.8 %) prostate cancer patients. This resulted in a higher indication (p < 0.05) of seminal vesicle irradiation (63.5 vs. 70.0 %), inclusion of any extracapsular disease (T3–T4) within the target volume (1.8 vs. 18.2 %), higher doses (65.3 vs. 88.3 %) and HT associated to RT (45.6 vs. 62.4 %). Global accuracy for mpMRI was higher compared to DRE/TRUS (8.9 vs. 71.1 %, p < 0.05). mpMRI reliability was independent of PSA or GS. mpMRI tumor staging significantly modified the RT treatment decisions in all prostate cancer risk groups.
Highlights
Clinical tumoural category is a determining factor in prostate cancer management
(PSA value, Gleason score (GS), % ppb and age) showed a significant association with multiparametric magnetic resonance imaging (mpMRI) reliability (Table 4). We believe that this is the largest cohort of patients in which the impact of mpMRI staging on radiotherapy treatment (RT) treatment has been analysed
T-category T1–T2a T2b–T2c T3–T4 Risk group Low-risk Intermediate-risk High-risk Global reliability for T-category Risk group change due to pathological analysis Changes related to RT parameters (HT, Doses, clinical target volume (CTV)) Initial criteria memorial sloan kettering cancer center (MSKCC) criteria
Summary
Clinical tumoural category (cT-category) is a determining factor in prostate cancer management. In determining the cT-category in prostate cancer, digital rectal examination (DRE) and transrectal ultrasound (TRUS) remain the gold-standard methods recommended in almost all guidelines and protocols (Mohler et al 2014; Heidenreich et al 2014). Both tests have very low reliability and high interobserver variability (Philip et al 2005; Smith and Catalona 1995). This could result in erroneous estimation of the cT-category, potentially resulting in inappropriate treatment, in relation to RT. Few studies have focused on the Couñago et al SpringerPlus (2015) 4:789 impact of mpMRI staging in relation to RT target volumes, total dose administered, or the use of HT (Couñago et al 2014; Panje et al 2015)
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