Are clinical factors predictive of prostate cancer T stage as assessed by mpMRI? A study on patients addressed to external beam radiation therapy

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-1224

Type:

Scientific Exhibit

Keywords:

Genital / Reproductive system male, MR, Diagnostic procedure, Radiation therapy / Oncology, Cancer

Authors:

M. Zerial, M. A. Signor, S. Bednarova, M. Zanotel, L. Cereser, C. Zuiani, R. Girometti; Udine/IT

DOI:

10.1594/ecr2017/C-1224

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-1224

Table 1: mpMRI protocol for prostate cancer. See the text for further details,...

Table 2: Criteria for theT staging on mpMRI.

Table 3: Scoring system to attribute ECE and/or SVI on mpMRI.

Table 4: Clinical features of the study groups, together with the rsults of mpMRI staging

Aims and objectives

Background Prostate-specific antigen (PSA), Gleason score (GS) and clinical T stage (cT) are the benchmarks for risk stratification of patients with prostate cancer (PCa), which in turn is crucial to define most adequate management [1]. Moreover, PSA, GS and cT have a role in predicting pathological T stage (pT) through the use of several nomograms, such as Partin tables [2] or the Memorial Sloan-Kettering Cancer Center one [3].On the other hand, the ever-increasing use of radiation therapy (RT) as a first-line treatment for PCa [4]...

Methods and materials

Study populationsIn the period January 2013 - December 2015 we prospectively enrolled all patients referred to RT who performed staging mpMRI of a biopsy-proven PCa (target group). Indication to RT and cT stadium had been previously defined by two radiation oncologists (experience of 10 and 20 years) using Partin tables [6]. They also provided risk stratification in accordance with the national comprehensive cancer network (NCCN) criteria. Exclusion criteria were contraindications to MRI, patients’ choice of primary treatment other than EBRT and incomplete or lacking information...

Results

Study populationsThe descriptive characteristics of the target group (patients referred to RT) and validation groups (surgical patients) are shown in Tab. 4.In the surgical group, sensitivity and specificity for pT≥3 were 86.3% (95%C.I. 77.3-95.4) and 93.9% (95%C.I. 86.8-99.9), respectively. In particular, mpMRI missed three microscopic pT3a cancers and induced 2 false-positives.Prediction of mpMRI-TIn the mpMRI group, patients were staged T≤2 in 47/73 cases (64.4%; I.C.95 52.2-75.0%) and ≥T3 in 26/73 cases (35.6%; I.C.95 25.0- 47.8%).Results of the multivariate analysis are shown in Tab. 5. Overall,...

Conclusion

GS ≥8 predicts mp-MRI-T≥3 stage (ECE and/or SVI) in patients referred to RT. GS 7 is a weak predictor of ECE alone. As supported by excellent sensitivity and specificity we found in the surgical validation group (86.3% and 96.9%, respectively), one can suppose GS has the potential to stratify patients to be addressed to mpMRI staging before RT.

Personal information

References

1. National Comprehensive Cancer Network (NCCN) clinical practice guidelines in Oncology. Prostate cancer. http://www.nccn.org   2. Eifler JB, Feng Z, Lin BM, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU International 2012;111:22-29   3. Shahrokh FS, Kattan MW, Vickers AJ, et al. Critical review of prostate cancer predictive tools. Future Oncol 2009;5:1555- 1584   4. Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update...