Background: Post-radiotherapy locally recurrent prostate cancer (PCa) patients are candidates for focal salvage treatment. Multiparametric MRI (mp-MRI) is attractive for tumor localization. However, radiotherapy-induced tissue changes complicate image interpretation. To develop focal salvage strategies, accurate tumor localization and distinction from benign tissue is necessary. Purpose: To quantitatively characterize radio-recurrent tumor and benign radiation-induced changes using mp-MRI, and investigate which sequences optimize the distinction between tumor and benign surroundings. Study Type: Prospective case–control. Subjects: Thirty-three patients with biochemical failure after external-beam radiotherapy (cases), 35 patients without post-radiotherapy recurrent disease (controls), and 13 patients with primary PCa (untreated). Field Strength/Sequences: 3T; quantitative mp-MRI: T2-mapping, ADC, and Ktrans and kep maps. Assessment: Quantitative image-analysis of prostatic regions, within and between cases, controls, and untreated patients. Statistical Tests: Within-groups: nonparametric Friedman analysis of variance with post-hoc Wilcoxon signed-rank tests; between-groups: Mann–Whitney tests. All with Bonferroni corrections. Generalized linear mixed modeling to ascertain the contribution of each map and location to tumor likelihood. Results: Benign imaging values were comparable between cases and controls (P = 0.15 for ADC in the central gland up to 0.91 for kep in the peripheral zone), both with similarly high peri-urethral Ktrans and kep values (min−1) (median [range]: Ktrans = 0.22 [0.14–0.43] and 0.22 [0.14–0.36], P = 0.60, kep = 0.43 [0.24–0.57] and 0.48 [0.32–0.67], P = 0.05). After radiotherapy, benign central gland values were significantly decreased for all maps (P ≤ 0.001) as well as T2, Ktrans, and kep of benign peripheral zone (all with P ≤ 0.002). All imaging maps distinguished recurrent tumor from benign peripheral zone, but only ADC, Ktrans, and kep were able to distinguish it from benign central gland. Recurrent tumor and peri-urethral Ktrans values were not significantly different (P = 0.81), but kep values were (P < 0.001). Combining all quantitative maps and voxel location resulted in an optimal distinction between tumor and benign voxels. Data Conclusion: Mp-MRI can distinguish recurrent tumor from benign tissue. Level of Evidence: 2. Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2019;50:269–278.
Bibliographical noteFunding Information:
Contract grant sponsor: Dutch Cancer Society; Contract grant number: NKI 2013–5937 and project 10088. The authors thank Susanne van der Sanden, Manon Verwijs, Corinne Tillier, Barry Doodeman, Gerbert Vrijenhoek, and Tineke Vijlbrief-Bosman for help with patient inclusion. We also thank Katarzyna Jozwiak for providing valuable statistical advice.
© 2018 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.
Copyright 2019 Elsevier B.V., All rights reserved.
- Case-Control Studies
- Hormones/therapeutic use
- Multiparametric Magnetic Resonance Imaging
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Prospective Studies
- Prostate/diagnostic imaging
- Prostatic Neoplasms/diagnostic imaging
- Salvage Therapy