Multiparametrik prostat MRI'nın lokalize prostat kanserinde tedavi seçimi ve erken nüks saptamaya etkisi
Öz
Amaç: Çalışmada amacımız, prostat kanseri tanısında, giderek kullanımı artan multiparametrik prostat MRG’nin lokalize hastalıkta tedavi kararlarındaki potansiyel rolünü ve tedavi sonrası erken dönemde nüksü belirlemede prognostik önemini araştırmaktır.
Gereç ve Yöntem: Lokalize prostat kanseri tanısı alan 114 olgunun risk sınıflamasını belirleyen ISUP derecesi, prostat spesifik antijen (PSA), serbest PSA, prostat volüm ile mp-MRI incelemede indeks lezyon çapı, görünür difüzyon katsayısı (ADC) değeri, kapsül temas uzunluğu, ekstrakapsular uzanım ve seminal vezikül invazyonu varlığının biyokimyasal nüks ile ilişkisi araştırılmıştır. Gruplar arasındaki radyolojik ve klinik özelliklerin dağılımındaki farklılıklar, ki-kare testi kullanılarak istatistiksel olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen 114 hastanın 49'una radyoterapi, 61'ine radikal prostatektomi olmak üzere küratif tedavi uygulanmıştır. Dört hasta ise yan etkileri ertelemek amacıyla aktif izlem protokolüne alınmıştır. Takipte 13 (11,4%) hastada PSA veya lokal nüks meydana gelmiştir. Nüksüz hastalık ile ekstrakapsüler invazyon yokluğu(p=0,022) ve ISUP derecesi (p=0,025) arasında istatistik olarak anlamlı bir ilişki gözlenmiştir. İndeks lezyon çapı ölçümü (p=0,005) ve kapsül temas uzunluğu ölçümü(p=0,015) ile erken dönem nüks hastalık arasında istatiksel olarak anlamlı ilişki gözlenmiş olup, ISUP derecesi arttıkça ve klinik evre arttıkça ADC değeri düşmekteydi (p=0,001). Sonuç: Bu çalışmanın bulguları, mp-MRI'nin lokalize prostat kanseri hastalarında risk sınıflandırması ve riske dayalı tedavi kararları vermek için kullanılabileceğini göstermektedir.
Anahtar Kelimeler
Prostat kanser multiparametrik MRI risk faktörleri lezyon çapı kapsül temas uzunluğu
Kaynakça
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA A Cancer J Clinicians. 2022;72(1):7- 33.
- Hutten R, Khouri A, Parsons M, Tward A, Wilson T, Peterson J, et al. The Clinical Significance of Maximum Tumor Diameter on MRI in Men Undergoing Radical Prostatectomy or Definitive Radiotherapy for Locoregional Prostate Cancer. Clinical Genitourinary Cancer. 2022;20(6):453-459.
- Dall’Era MA, Albertsen PC, Bangma C, Carroll PR, Carter HB, Cooperberg MR, et al. Active Surveillance for Prostate Cancer: A Systematic Review of the Literature. European Urology. 2012;62(6):976-83.
- Woo S, Han S, Kim T, Suh CH, Westphalen AC, Hricak H, et al. Prognostic Value of Pretreatment MRI in Patients With Prostate Cancer Treated With Radiation Therapy: A Systematic Review and Meta-Analysis. American Journal of Roentgenology. 2020;214(3):597-604.
- Angulo JC, Montie JE, Bukowsky T, Chakrabarty A, Grignon DJ, Sakr W, et al. Interobserver consistency of digital rectal examination in clinical staging of localized prostatic carcinoma. Urologic Oncology: Seminars and Original Investigations. 1995;1(5):199-205.
- Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading System and Factoring in Tertiary Grades. European Urology. 2012;61(5):1019-24.
- Ho R, Siddiqui MM, George AK, Frye T, Kilchevsky A, Fascelli M, et al. Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy. PLoS ONE. 2016; 11(6):e0157313.
- Boccon-Gibod L, Bertaccini A, Bono AV, Dev Sarmah B, Höltl W, Mottet N, et al. Management of locally advanced prostate cancer: a European consensus. Int J Clin Pract. 2003;57(3):187-94.
- Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff R, Storme G, et al. Improved Survival in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy and Goserelin. N Engl J Med. 1997;337(5):295-300.
- Buyyounouski MK, Choyke PL, McKenney JK, Sartor O, Sandler HM, Amin MB, et al. Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA A Cancer J Clinicians. 2017;67(3):245-53.
- Litwin MS, Tan H. The Diagnosis and Treatment of Prostate Cancer. JAMA. 2017;317(24):2532.
- Lim CS, McInnes MD, Lim RS, Breau RH, Flood TA, Krishna S, et al. Prognostic value of Prostate Imaging and Data Reporting System (PI-RADS) v. 2 assessment categories 4 and 5 compared to histopathological outcomes after radical prostatectomy. J Magn Reson Imaging. 2017;46(1):257-66.
- Kauffmann G, Arif F, Patel P, Oto A, Liauw SL. Pretreatment multiparametric MRI is independently associated with biochemical outcome in men treated with radiation therapy for prostate cancer. Urologic Oncology: Seminars and Original Investigations. 2018;36(10):471.e11-471.e18.
- Gorovets D, Wibmer AG, Moore A, Lobaugh S, Zhang Z, Kollmeier M, et al. Local Failure after Prostate SBRT Predominantly Occurs in the PI-RADS 4 or 5 Dominant Intraprostatic Lesion. European Urology Oncology. 2023;6(3):275-81.
- Dahan J, Delouya G, Lambert C, Olivié DAR, Billiard J, Taussky D. Findings on Diagnostic Magnetic Resonance Imaging Before Radiotherapy for Prostate Cancer. Can Assoc Radiol J. 2023;74(2):382-7.
- Caglic I, Kovac V, Barrett T. Multiparametric MRI - local staging of prostate cancer and beyond. Radiology and Oncology. 2019;53(2):159-70.
- Eurboonyanun K, Pisuchpen N, O’Shea A, Lahoud RM, Atre ID, Harisinghani M. The absolute tumor-capsule contact length in the diagnosis of extraprostatic extension of prostate cancer. Abdom Radiol. 2021;46(8):4014-24.
- Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016;375(15):1415-24.
- Kayat Bittencourt L, Litjens G, Hulsbergen-van de Kaa CA, Turkbey B, Gasparetto EL, Barentsz JO. Prostate Cancer: The European Society of Urogenital Radiology Prostate Imaging Reporting and Data System Criteria for Predicting Extraprostatic Extension by Using 3-T Multiparametric MR Imaging. Radiology. 2015;276(2):479-89.
- Park CK, Chung YS, Choi YD, Ham WS, Jang WS, Cho NH. Revisiting extraprostatic extension based on invasion depth and number for new algorithm for substaging of pT3a prostate cancer. Sci Rep. 2021;11(1): 13952.
The efficacy of multiparametric prostate MRI in making treatment decisions and predicting early recurrence in localized prostate cancer
Öz
Aim: This study investigates the potential role of multiparametric magnetic resonance imaging (mp-MRI) in localized prostate cancer, its impact on treatment decision-making and its predictability of the likelihood of cancer recurrence after treatment.
Material and Method: The relationships between ISUP grade groups, prostate volume, prostate-specific antigen (PSA), and free PSA values that determine the risk classification of 114 cases diagnosed with localized prostate cancer, mp-MRI findings, including index lesion diameter, apparent diffusion coefficient (ADC) value, capsule contact length, extracapsular extension, and presence of seminal vesicle invasion, and biochemical recurrence, were investigated.
Results: Of the 114 patients included in the study, 49 underwent radiotherapy and 61 underwent radical prostatectomy as curative treatments. Four patients were enrolled in an active surveillance protocol to delay potential side effects. PSA or local recurrence occurred in 13 (11.4%) patients during the follow-up period. There was a significant correlation between stable disease and absence of extracapsular invasion (p=0.022) and ISUP grade (p=0.025). There was also a significant correlation between index lesion diameter (p=0.005), capsule contact length (p=0.015), and recurrence. Additionally, the ADC value decreased as the ISUP grade and clinical stage increased (p=0.001). Conclusion: This study's findings indicate that mp-MRI can be used for risk stratification and making risk-based treatment decisions in localized prostate cancer patients.
Anahtar Kelimeler
Prostate cancer multiparametric prostate MRI risk factors lesion diameter capsule contact length
Etik Beyan
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study protocol was approved by the Akdeniz University’s ethics committee (Approval Date: 24.05.2023, Approval No.424).
Destekleyen Kurum
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Kaynakça
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA A Cancer J Clinicians. 2022;72(1):7- 33.
- Hutten R, Khouri A, Parsons M, Tward A, Wilson T, Peterson J, et al. The Clinical Significance of Maximum Tumor Diameter on MRI in Men Undergoing Radical Prostatectomy or Definitive Radiotherapy for Locoregional Prostate Cancer. Clinical Genitourinary Cancer. 2022;20(6):453-459.
- Dall’Era MA, Albertsen PC, Bangma C, Carroll PR, Carter HB, Cooperberg MR, et al. Active Surveillance for Prostate Cancer: A Systematic Review of the Literature. European Urology. 2012;62(6):976-83.
- Woo S, Han S, Kim T, Suh CH, Westphalen AC, Hricak H, et al. Prognostic Value of Pretreatment MRI in Patients With Prostate Cancer Treated With Radiation Therapy: A Systematic Review and Meta-Analysis. American Journal of Roentgenology. 2020;214(3):597-604.
- Angulo JC, Montie JE, Bukowsky T, Chakrabarty A, Grignon DJ, Sakr W, et al. Interobserver consistency of digital rectal examination in clinical staging of localized prostatic carcinoma. Urologic Oncology: Seminars and Original Investigations. 1995;1(5):199-205.
- Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading System and Factoring in Tertiary Grades. European Urology. 2012;61(5):1019-24.
- Ho R, Siddiqui MM, George AK, Frye T, Kilchevsky A, Fascelli M, et al. Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy. PLoS ONE. 2016; 11(6):e0157313.
- Boccon-Gibod L, Bertaccini A, Bono AV, Dev Sarmah B, Höltl W, Mottet N, et al. Management of locally advanced prostate cancer: a European consensus. Int J Clin Pract. 2003;57(3):187-94.
- Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff R, Storme G, et al. Improved Survival in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy and Goserelin. N Engl J Med. 1997;337(5):295-300.
- Buyyounouski MK, Choyke PL, McKenney JK, Sartor O, Sandler HM, Amin MB, et al. Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA A Cancer J Clinicians. 2017;67(3):245-53.
- Litwin MS, Tan H. The Diagnosis and Treatment of Prostate Cancer. JAMA. 2017;317(24):2532.
- Lim CS, McInnes MD, Lim RS, Breau RH, Flood TA, Krishna S, et al. Prognostic value of Prostate Imaging and Data Reporting System (PI-RADS) v. 2 assessment categories 4 and 5 compared to histopathological outcomes after radical prostatectomy. J Magn Reson Imaging. 2017;46(1):257-66.
- Kauffmann G, Arif F, Patel P, Oto A, Liauw SL. Pretreatment multiparametric MRI is independently associated with biochemical outcome in men treated with radiation therapy for prostate cancer. Urologic Oncology: Seminars and Original Investigations. 2018;36(10):471.e11-471.e18.
- Gorovets D, Wibmer AG, Moore A, Lobaugh S, Zhang Z, Kollmeier M, et al. Local Failure after Prostate SBRT Predominantly Occurs in the PI-RADS 4 or 5 Dominant Intraprostatic Lesion. European Urology Oncology. 2023;6(3):275-81.
- Dahan J, Delouya G, Lambert C, Olivié DAR, Billiard J, Taussky D. Findings on Diagnostic Magnetic Resonance Imaging Before Radiotherapy for Prostate Cancer. Can Assoc Radiol J. 2023;74(2):382-7.
- Caglic I, Kovac V, Barrett T. Multiparametric MRI - local staging of prostate cancer and beyond. Radiology and Oncology. 2019;53(2):159-70.
- Eurboonyanun K, Pisuchpen N, O’Shea A, Lahoud RM, Atre ID, Harisinghani M. The absolute tumor-capsule contact length in the diagnosis of extraprostatic extension of prostate cancer. Abdom Radiol. 2021;46(8):4014-24.
- Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016;375(15):1415-24.
- Kayat Bittencourt L, Litjens G, Hulsbergen-van de Kaa CA, Turkbey B, Gasparetto EL, Barentsz JO. Prostate Cancer: The European Society of Urogenital Radiology Prostate Imaging Reporting and Data System Criteria for Predicting Extraprostatic Extension by Using 3-T Multiparametric MR Imaging. Radiology. 2015;276(2):479-89.
- Park CK, Chung YS, Choi YD, Ham WS, Jang WS, Cho NH. Revisiting extraprostatic extension based on invasion depth and number for new algorithm for substaging of pT3a prostate cancer. Sci Rep. 2021;11(1): 13952.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Radyoloji ve Organ Görüntüleme |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Mart 2025 |
| Gönderilme Tarihi | 26 Eylül 2024 |
| Kabul Tarihi | 1 Ocak 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: 1 |
