The prognostic value, sensitivity, and specificity of multiparametric magnetic resonance imaging before salvage radiotherapy for prostate cancer. (August 2021)

• Record Type: Journal Article
• Authors: Breen, William G.; Stish, Bradley J.; Harmsen, William S.; Froemming, Adam T.; Mynderse, Lance A.; Choo, C. Richard; Davis, Brian J.; Pisansky, Thomas M.
• Is Part Of: Radiotherapy and oncology. Volume 161(2021)
• Page Start: 9
• Page End: 15
• Publication Date: 2021-08
• Subjects: MRI Magnetic resonance imaging -- SRT salvage radiation therapy -- BCR biochemical recurrence -- DM distant metastasis -- PCSM prostate cancer specific mortality -- ADT androgen deprivation therapy -- PPV positive predictive value -- NPV negative predictive value -- RP radical prostatectomy -- PCa prostate cancer -- PSA prostate specific antigen -- NCCN National Comprehensive Cancer Network -- PET positron emission tomography -- DCE dynamic-contrast-enhanced -- VUA vesicourethral anastomosis -- HR hazard ratio -- UVA univariate analysis -- ISUP International Society of Urological Pathology -- GG grade group -- MVA multivariate analysis; Prostate cancer -- MRI -- Radiotherapy -- Salvage radiotherapy; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.05.015
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: MRI is commonly used at the time of biochemical recurrence following prostatectomy. The operational characteristics of MRI after biochemical recurrence are unknown. Sensitivity, specificity, PPV, and NPV of MRI were 61%, 60%, 86%, and 28% Sensitivity improves with higher PSA, while specificity improves with lower PSA. Abstract: Aim: To determine the operational characteristics of pelvic magnetic resonance imaging (MRI) prior to salvage radiation therapy (SRT) for biochemically recurrent prostate cancer following radical prostatectomy. Methods and materials: We reviewed the medical records of 386 patients who underwent MRI prior to SRT. We assessed associations of pre-SRT MRI findings with biochemical recurrence (BCR), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and salvage androgen deprivation therapy (ADT) use following SRT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI for detecting local recurrence were also calculated. Results: Pre-SRT MRI was positive for local recurrence in 216 patients (56%), indeterminate in 46 (12%), and negative in 124 (32%). On univariate analysis, BCR following SRT was significantly less likely for patients with positive (HR: 0.58, 95% CI: 0.42–0.8) or indeterminate (HR: 0.6: 0.36–1) MRI findings, compared to patients with negative imaging ( p = 0.003). These associations remained significant on multivariate analysis ( p < 0.05) and across pre-SRT PSA groups. For the entire cohort, the sensitivity of MRI for local recurrence was 61.0% (53.5–68.1%), specificity 60.0% (44.3–73.0%), PPV 86.1% (78.9–91.5%) and NPV 27.6% (19.0–37.5%). Sensitivity of MRI was better in men with higher pre-SRT PSA (80.0% for PSA > 1.0), and specificity was improved with lower pre-SRT PSA (73.9% for PSA 0.1–0.5). Conclusions: Positive or indeterminate MRI findings prior to SRT were associated with improved biochemical control following SRT, across PSA levels. The sensitivity and specificity of MRI for local recurrence were 61% and 58.7%, respectively.