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

Audrey Asuncion; Paul Michael Walker; Aurélie Bertaut; Julie Blanc; Maxime Labarre; Etienne Martin; Florian Bardet; Jeremy Cassin; Luc Cormier; Gilles Crehange; Romaric Loffroy; Alexandre Cochet

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

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

Authors

Audrey Asuncion¹, Paul Michael Walker^{2

3}, Aurélie Bertaut⁴, Julie Blanc⁴, Maxime Labarre⁵, Etienne Martin⁶, Florian Bardet⁷, Jeremy Cassin¹, Luc Cormier⁷, Gilles Crehange⁸, Romaric Loffroy^{1

3}, Alexandre Cochet^{2

3

9}

Affiliations

¹ Department of Diagnostic & Interventional Radiology, University Hospital Dijon, Dijon, France.
² Department of Spectroscopy and Nuclear Magnetic Resonance, University Hospital Dijon, Dijon, France.
³ Laboratory of Imaging and Artificial Vision (ImVIA), IFTIM Team, EA 7535, University of Burgundy, Dijon, France.
⁴ Department of Methodology and biostatistics, Centre Georges-François-Leclerc, Dijon, France.
⁵ Department of Radiology, Centre Georges-François-Leclerc, Dijon, France.
⁶ Department of Radiotherapy, Centre Georges-François-Leclerc, Dijon, France.
⁷ Department of Urology, University Hospital Dijon, Dijon, France.
⁸ Department of Radiotherapy, Institut Curie, Paris, France.
⁹ Department of Nuclear Medicine, Centre Georges-François-Leclerc, Dijon, France.

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.