mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy

• Published in: Urologic oncology Vol. 37; no. 6; pp. 352.e25 - 352.e30
• Main Authors: Gold, Samuel A., VanderWeele, David J., Harmon, Stephanie, Bloom, Jonathan B., Karzai, Fatima, Hale, Graham R., Marhamati, Shawn, Rayn, Kareem N., Mehralivand, Sherif, Merino, Maria J., Gulley, James L., Bilusic, Marijo, Madan, Ravi A., Choyke, Peter L., Turkbey, Baris, Dahut, William, Pinto, Peter A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Aged; Androgen Antagonists - therapeutic use; Androgen deprivation; Antineoplastic Agents, Hormonal - therapeutic use; Benzamides; Enzalutamide; Goserelin - therapeutic use; Humans; Male; Middle Aged; Multiparametric Magnetic Resonance Imaging; Multiparametric MRI; Neoplasm Staging - methods; Nitriles; Phenylthiohydantoin - analogs & derivatives; Phenylthiohydantoin - therapeutic use; Preoperative Period; Prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Robotic Surgical Procedures; Enzalutamide; Androgen deprivation; Prostate cancer; Multiparametric MRI
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2019.01.012

•Antiandrogen therapy drastically changes the prostate's appearance on MRI.•MRI correctly staged 17/20 patients as organ-confined or not.•MRI had a positive predictive value of 85% for cancerous lesions.•T2W MRI sequence was most accurate for staging. Using multiparametric magnetic resonance imaging (mpMRI), we sought to preoperatively characterize prostate cancer (PCa) in the setting of antiandrogen plus androgen deprivation therapy (AA-ADT) prior to robotic-assisted radical prostatectomy (RARP). We present our preliminary findings regarding mpMRI depiction of changes of disease staging features and lesion appearance in treated prostate. Prior to RARP, men received 6 months of enzalutamide and goserelin. mpMRI consisting of T2 weighted, b = 2,000 diffusion weighted imaging, apparent diffusion coefficient mapping, and dynamic contrast enhancement sequences was acquired before and after neoadjuvant therapy. Custom MRI-based prostate molds were printed to directly compare mpMRI findings to H&E whole-mount pathology as part of a phase II clinical trial (NCT02430480). Twenty men underwent imaging and RARP after a regimen of AA-ADT. Positive predictive values for post-AA-ADT mpMRI diagnosis of extraprostatic extension, seminal vesicle invasion, organ-confined disease, and biopsy-confirmed PCa lesions were 71%, 80%, 80%, and 85%, respectively. Post-treatment mpMRI correctly staged disease in 15/20 (75%) cases with 17/20 (85%) correctly identified as organ-confined or not. Of those incorrectly staged, 2 were falsely positive for higher stage features and 1 was falsely negative. Post-AA-ADT T2 weighted sequences best depicted presence of PCa lesions as compared to diffusion weighted imaging and dynamic contrast enhancement sequences. mpMRI proved reliable in detecting lesion changes after antiandrogen therapy corresponding to PCa pathology. Therefore, mpMRI of treated prostates may be helpful for assessing men for surgical planning and staging.