Prostate cancer

Role of pretreatment MR in predicting outcome after external-beam radiation therapy - Initial experience

David A. McKenna, Fergus Coakley, Antonio C. Westphalen, Shoujun Zhao, Ying Lu, Emily M. Webb, Barby Pickett, Mack Roach, John Kurhanewicz

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose: To retrospectively determine if pretreatment endorectal magnetic resonance (MR) imaging findings are predictive of outcome in patients who undergo external-beam radiation therapy for prostate cancer. Materials and Methods: Committee on Human Research approval, with waiver of the requirement for informed consent, was obtained for this HIPAA-compliant study. Eighty men with biopsy-proved prostate cancer (mean age, 59 years; range, 47-75 years) who underwent endorectal MR imaging of the prostate prior to external-beam radiation therapy were retrospectively identified; details of baseline tumor characteristics, treatment, and outcome were recorded. Two experienced readers independently reviewed all MR imaging studies and recorded tumor T stage and the radial diameter of extracapsular extension (if present). Univariate and multivariate stepwise Cox regression analyses were used to investigate the relationship between baseline imaging and clinical predictive variables and the end point of metastatic failure. Results: At MR imaging, readers 1 and 2, respectively, considered 50 and 60 patients to have T1 or T2 disease (ie, organconfined disease) and 30 and 20 patients to have T3 disease. After a mean follow-up of 43 months, four patients developed metastases. Univariate Cox analysis revealed that baseline serum prostate-specific antigen level, presence of extracapsular extension at MR imaging (according to either reader), and degree of extracapsular extension (according to either reader) were all significantly (P <.05) related to the development of metastases. Multivariate Cox analysis revealed that the sole independent predictive variable was mean diameter of extracapsular extension (relative hazard ratio, 2.06; 95% confidence interval: 1.22, 3.48; P = .007). In particular, three of five patients with extracapsular extension of more than 5 mm at pretreatment MR imaging developed metastases 24, 43, and 63 months after therapy. Conclusion: The presence and degree of extracapsular extension at MR imaging prior to external-beam radiation therapy are important predictors of posttreatment metastatic recurrence.

Original languageEnglish (US)
Pages (from-to)141-146
Number of pages6
JournalRadiology
Volume247
Issue number1
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Prostatic Neoplasms
Magnetic Resonance Spectroscopy
Radiotherapy
Magnetic Resonance Imaging
Neoplasm Metastasis
Health Insurance Portability and Accountability Act
Prostate-Specific Antigen
Informed Consent
Prostate
Neoplasms
Multivariate Analysis
Regression Analysis
Confidence Intervals
Biopsy
Recurrence
Serum
Research

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Prostate cancer : Role of pretreatment MR in predicting outcome after external-beam radiation therapy - Initial experience. / McKenna, David A.; Coakley, Fergus; Westphalen, Antonio C.; Zhao, Shoujun; Lu, Ying; Webb, Emily M.; Pickett, Barby; Roach, Mack; Kurhanewicz, John.

In: Radiology, Vol. 247, No. 1, 04.2008, p. 141-146.

Research output: Contribution to journalArticle

McKenna, DA, Coakley, F, Westphalen, AC, Zhao, S, Lu, Y, Webb, EM, Pickett, B, Roach, M & Kurhanewicz, J 2008, 'Prostate cancer: Role of pretreatment MR in predicting outcome after external-beam radiation therapy - Initial experience', Radiology, vol. 247, no. 1, pp. 141-146. https://doi.org/10.1148/radiol.2471061982
McKenna, David A. ; Coakley, Fergus ; Westphalen, Antonio C. ; Zhao, Shoujun ; Lu, Ying ; Webb, Emily M. ; Pickett, Barby ; Roach, Mack ; Kurhanewicz, John. / Prostate cancer : Role of pretreatment MR in predicting outcome after external-beam radiation therapy - Initial experience. In: Radiology. 2008 ; Vol. 247, No. 1. pp. 141-146.
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abstract = "Purpose: To retrospectively determine if pretreatment endorectal magnetic resonance (MR) imaging findings are predictive of outcome in patients who undergo external-beam radiation therapy for prostate cancer. Materials and Methods: Committee on Human Research approval, with waiver of the requirement for informed consent, was obtained for this HIPAA-compliant study. Eighty men with biopsy-proved prostate cancer (mean age, 59 years; range, 47-75 years) who underwent endorectal MR imaging of the prostate prior to external-beam radiation therapy were retrospectively identified; details of baseline tumor characteristics, treatment, and outcome were recorded. Two experienced readers independently reviewed all MR imaging studies and recorded tumor T stage and the radial diameter of extracapsular extension (if present). Univariate and multivariate stepwise Cox regression analyses were used to investigate the relationship between baseline imaging and clinical predictive variables and the end point of metastatic failure. Results: At MR imaging, readers 1 and 2, respectively, considered 50 and 60 patients to have T1 or T2 disease (ie, organconfined disease) and 30 and 20 patients to have T3 disease. After a mean follow-up of 43 months, four patients developed metastases. Univariate Cox analysis revealed that baseline serum prostate-specific antigen level, presence of extracapsular extension at MR imaging (according to either reader), and degree of extracapsular extension (according to either reader) were all significantly (P <.05) related to the development of metastases. Multivariate Cox analysis revealed that the sole independent predictive variable was mean diameter of extracapsular extension (relative hazard ratio, 2.06; 95{\%} confidence interval: 1.22, 3.48; P = .007). In particular, three of five patients with extracapsular extension of more than 5 mm at pretreatment MR imaging developed metastases 24, 43, and 63 months after therapy. Conclusion: The presence and degree of extracapsular extension at MR imaging prior to external-beam radiation therapy are important predictors of posttreatment metastatic recurrence.",
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AU - Zhao, Shoujun

AU - Lu, Ying

AU - Webb, Emily M.

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N2 - Purpose: To retrospectively determine if pretreatment endorectal magnetic resonance (MR) imaging findings are predictive of outcome in patients who undergo external-beam radiation therapy for prostate cancer. Materials and Methods: Committee on Human Research approval, with waiver of the requirement for informed consent, was obtained for this HIPAA-compliant study. Eighty men with biopsy-proved prostate cancer (mean age, 59 years; range, 47-75 years) who underwent endorectal MR imaging of the prostate prior to external-beam radiation therapy were retrospectively identified; details of baseline tumor characteristics, treatment, and outcome were recorded. Two experienced readers independently reviewed all MR imaging studies and recorded tumor T stage and the radial diameter of extracapsular extension (if present). Univariate and multivariate stepwise Cox regression analyses were used to investigate the relationship between baseline imaging and clinical predictive variables and the end point of metastatic failure. Results: At MR imaging, readers 1 and 2, respectively, considered 50 and 60 patients to have T1 or T2 disease (ie, organconfined disease) and 30 and 20 patients to have T3 disease. After a mean follow-up of 43 months, four patients developed metastases. Univariate Cox analysis revealed that baseline serum prostate-specific antigen level, presence of extracapsular extension at MR imaging (according to either reader), and degree of extracapsular extension (according to either reader) were all significantly (P <.05) related to the development of metastases. Multivariate Cox analysis revealed that the sole independent predictive variable was mean diameter of extracapsular extension (relative hazard ratio, 2.06; 95% confidence interval: 1.22, 3.48; P = .007). In particular, three of five patients with extracapsular extension of more than 5 mm at pretreatment MR imaging developed metastases 24, 43, and 63 months after therapy. Conclusion: The presence and degree of extracapsular extension at MR imaging prior to external-beam radiation therapy are important predictors of posttreatment metastatic recurrence.

AB - Purpose: To retrospectively determine if pretreatment endorectal magnetic resonance (MR) imaging findings are predictive of outcome in patients who undergo external-beam radiation therapy for prostate cancer. Materials and Methods: Committee on Human Research approval, with waiver of the requirement for informed consent, was obtained for this HIPAA-compliant study. Eighty men with biopsy-proved prostate cancer (mean age, 59 years; range, 47-75 years) who underwent endorectal MR imaging of the prostate prior to external-beam radiation therapy were retrospectively identified; details of baseline tumor characteristics, treatment, and outcome were recorded. Two experienced readers independently reviewed all MR imaging studies and recorded tumor T stage and the radial diameter of extracapsular extension (if present). Univariate and multivariate stepwise Cox regression analyses were used to investigate the relationship between baseline imaging and clinical predictive variables and the end point of metastatic failure. Results: At MR imaging, readers 1 and 2, respectively, considered 50 and 60 patients to have T1 or T2 disease (ie, organconfined disease) and 30 and 20 patients to have T3 disease. After a mean follow-up of 43 months, four patients developed metastases. Univariate Cox analysis revealed that baseline serum prostate-specific antigen level, presence of extracapsular extension at MR imaging (according to either reader), and degree of extracapsular extension (according to either reader) were all significantly (P <.05) related to the development of metastases. Multivariate Cox analysis revealed that the sole independent predictive variable was mean diameter of extracapsular extension (relative hazard ratio, 2.06; 95% confidence interval: 1.22, 3.48; P = .007). In particular, three of five patients with extracapsular extension of more than 5 mm at pretreatment MR imaging developed metastases 24, 43, and 63 months after therapy. Conclusion: The presence and degree of extracapsular extension at MR imaging prior to external-beam radiation therapy are important predictors of posttreatment metastatic recurrence.

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