Local failure after prostate SBRT predominantly occurs in the PI-RADS 4 or 5 dominant intraprostatic lesion Journal Article
| Authors: | Gorovets, D.; Wibmer, A. G.; Moore, A.; Lobaugh, S.; Zhang, Z.; Kollmeier, M.; McBride, S.; Zelefsky, M. J. |
| Article Title: | Local failure after prostate SBRT predominantly occurs in the PI-RADS 4 or 5 dominant intraprostatic lesion |
| Abstract: | BACKGROUND: A positive post-treatment prostate biopsy following definitive radiotherapy carries significant prognostic implications. OBJECTIVE: To determine whether local recurrences after prostate stereotactic body radiation therapy (SBRT) are associated with the presence of and occur more commonly within the region of a PI-RADS 4 or 5 dominant intra-prostatic lesion (DIL) identified on pre-treatment multi-parametric magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: 247 patients with localized prostate cancer treated with SBRT at our institution from 2009-2018 underwent post-treatment biopsies (median time to biopsy: 2.2 years) to evaluate local control. INTERVENTIONS: Prostate SBRT (median 40 Gy in 5 fractions). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: MRIs were read by a single diagnostic radiologist blinded to other patient characteristics and treatment outcomes. The DIL presence, size, location, and extent were then analyzed to determine associations with the post-treatment biopsy outcomes. RESULTS AND LIMITATIONS: Among patients who underwent post-treatment biopsies, 39/247 (15.8%) were positive for Gleason-gradable prostate adenocarcinoma, of which 35/39 (90%) had a DIL initially present and 29/39 (74.4%) had a positive biopsy within the DIL. Factors independently associated with post-treatment biopsy outcomes included the presence of a DIL (OR 6.95; p = 0.001), radiographic T3 disease (OR 5.23, p < 0.001), SBRT dose ≥40 Gy (OR 0.26, p = 0.003), and use of androgen deprivation therapy (ADT; OR 0.28, p = 0.027). Among patients with a DIL (N = 149), the only factors associated with post-treatment biopsy outcomes included ≥50% percent cores positive (OR 2.4, p = 0.037), radiographic T3 disease (OR 4.04, p = 0.001), SBRT dose ≥40 Gy (OR 0.22, p < 0.001), and use of ADT (OR 0.21, p = 0.014). CONCLUSIONS: Our results suggest that men with PI-RADS 4 or 5 DILs have a higher risk of local recurrence after prostate SBRT and that most recurrences are located within the DIL. PATIENT SUMMARY: We found the presence of a dominant tumor on pre-treatment MRI was strongly associated with residual cancer within the prostate after SBRT and that most recurrences were within the dominant tumor. Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
| Keywords: | nuclear magnetic resonance imaging; magnetic resonance imaging; recurrence; pathology; diagnostic imaging; biopsy; prostate cancer; prostatic neoplasms; prostate; prostate tumor; radiosurgery; androgen antagonists; recurrent disease; antiandrogen; sbrt; procedures; humans; human; male; pi-rads |
| Journal Title: | European Urology Oncology |
| Volume: | 6 |
| Issue: | 3 |
| ISSN: | 2588-9311 |
| Publisher: | Elsevier BV |
| Date Published: | 2023-06-01 |
| Start Page: | 275 |
| End Page: | 281 |
| Language: | English |
| DOI: | 10.1016/j.euo.2022.02.005 |
| PUBMED: | 35307323 |
| PROVIDER: | scopus |
| PMCID: | PMC9481979 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Daniel Gorovets -- Source: Scopus |
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