Regarding the focal treatment of prostate cancer: Inference of the Gleason grade from magnetic resonance spectroscopic imaging Journal Article


Authors: Brame, R. S.; Zaider, M.; Zakian, K. L.; Koutcher, J. A.; Shukla-Dave, A.; Reuter, V. E.; Zelefsky, M. J.; Scardino, P. T.; Hricak, H.
Article Title: Regarding the focal treatment of prostate cancer: Inference of the Gleason grade from magnetic resonance spectroscopic imaging
Abstract: Purpose: To quantify, as a function of average magnetic resonance spectroscopy (MRS) score and tumor volume, the probability that a cancer-suspected lesion has an elevated Gleason grade. Methods and Materials: The data consist of MRS imaging ratios R stratified by patient, lesion (contiguous abnormal voxels), voxels, biopsy and pathologic Gleason grade, and lesion volume. The data were analyzed using a logistic model. Results: For both low and high Gleason score biopsy lesions, the probability of pathologic Gleason score ≥4+3 increases with lesion volume. At low values of R a lesion volume of at least 15-20 voxels is needed to reach a probability of success of 80%; the biopsy result helps reduce the prediction uncertainty. At larger MRS ratios (R > 6) the biopsy result becomes essentially uninformative once the lesion volume is >12 voxels. With the exception of low values of R, for lesions with low Gleason score at biopsy, the MRS ratios serve primarily as a selection tool for assessing lesion volumes. Conclusions: In patients with biopsy Gleason score ≥4+3, high MRS imaging tumor volume and (creatine + choline)/citrate ratio may justify the initiation of voxel-specific dose escalation. This is an example of biologically motivated focal treatment for which intensity-modulated radiotherapy and especially brachytherapy are ideally suited. © 2009 Elsevier Inc. All rights reserved.
Keywords: intensity modulated radiation therapy; treatment planning; radiation dose; tumor volume; logistic models; algorithms; biopsy; prostate cancer; gleason score; prostatic neoplasms; prostate; tumors; tumor burden; prostate biopsy; focal treatment; gleason grade; magnetic resonance spectroscopic imaging; brachytherapy; dose escalations; gleason scores; intensity-modulated radiotherapies; lesion volumes; prediction uncertainties; probability of success; tumor volumes; focusing; magnetic resonance; spin polarization; magnetic resonance spectroscopy; choline; citric acid; creatine; nuclear magnetic resonance spectroscopy
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 74
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2009-05-01
Start Page: 110
End Page: 114
Language: English
DOI: 10.1016/j.ijrobp.2008.07.055
PUBMED: 18990509
PROVIDER: scopus
PMCID: PMC2692099
DOI/URL:
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 30 November 2010" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    624 Zelefsky
  2. Peter T Scardino
    621 Scardino
  3. Hedvig Hricak
    333 Hricak
  4. Marco Zaider
    169 Zaider
  5. Amita Dave
    80 Dave
  6. Kristen L Zakian
    74 Zakian
  7. Jason A Koutcher
    236 Koutcher
  8. Victor Reuter
    922 Reuter