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

Samuel A. Gold; David James VanderWeele; Stephanie Harmon; Jonathan B. Bloom; Fatima Karzai; Graham R. Hale; Shawn Marhamati; Kareem N. Rayn; Sherif Mehralivand; Maria J. Merino; James L. Gulley; Marijo Bilusic; Ravi A. Madan; Peter L. Choyke; Baris Turkbey; William Dahut; Peter A. Pinto

doi:10.1016/j.urolonc.2019.01.012

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

Samuel A. Gold, David James VanderWeele, Stephanie Harmon, Jonathan B. Bloom, Fatima Karzai, Graham R. Hale, Shawn Marhamati, Kareem N. Rayn, Sherif Mehralivand, Maria J. Merino, James L. Gulley, Marijo Bilusic, Ravi A. Madan, Peter L. Choyke, Baris Turkbey, William Dahut, Peter A. Pinto^*

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.

Original language	English (US)
Pages (from-to)	352.e25-352.e30
Journal	Urologic Oncology: Seminars and Original Investigations
Volume	37
Issue number	6
DOIs	https://doi.org/10.1016/j.urolonc.2019.01.012
State	Published - Jun 2019

Funding

Dr. Mehralivand's postdoctoral fellowship is funded by a research grant from the Dr. Mildred Scheel Foundation (Bonn, Germany). This research was also made possible through the National Institutes of Health (NIH) Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, Genentech, the American Association for Dental Research, the Colgate-Palmolive Company, Elsevier, alumni of student research programs, and other individual supporters via contributions to the Foundation for the National Institutes of Health. This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research, and the Center for Interventional Oncology. NIH and Philips Healthcare have a cooperative research and development agreement. NIH and Philips share intellectual property in the field. This project has been funded in whole or in part with federal funds from the National Cancer Institute , National Institutes of Health , under contract no. HHSN261200800001E . The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Keywords

Androgen deprivation
Enzalutamide
Multiparametric MRI
Prostate cancer

ASJC Scopus subject areas

Oncology
Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.urolonc.2019.01.012

Cite this

Gold, S. A., VanderWeele, D. J., Harmon, S., Bloom, J. B., Karzai, F., Hale, G. R., Marhamati, S., Rayn, K. N., Mehralivand, S., Merino, M. J., Gulley, J. L., Bilusic, M., Madan, R. A., Choyke, P. L., Turkbey, B., Dahut, W., & Pinto, P. A. (2019). mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy. Urologic Oncology: Seminars and Original Investigations, 37(6), 352.e25-352.e30. https://doi.org/10.1016/j.urolonc.2019.01.012

@article{1c222bd1f8e2445c80a40ab89d312499,

title = "mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy",

abstract = "Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.",

keywords = "Androgen deprivation, Enzalutamide, Multiparametric MRI, Prostate cancer",

author = "Gold, {Samuel A.} and VanderWeele, {David James} and Stephanie Harmon and Bloom, {Jonathan B.} and Fatima Karzai and Hale, {Graham R.} and Shawn Marhamati and Rayn, {Kareem N.} and Sherif Mehralivand and Merino, {Maria J.} and Gulley, {James L.} and Marijo Bilusic and Madan, {Ravi A.} and Choyke, {Peter L.} and Baris Turkbey and William Dahut and Pinto, {Peter A.}",

note = "Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = jun,

doi = "10.1016/j.urolonc.2019.01.012",

language = "English (US)",

volume = "37",

pages = "352.e25--352.e30",

journal = "Urologic Oncology: Seminars and Original Investigations",

issn = "1078-1439",

publisher = "Elsevier Inc.",

number = "6",

}

Gold, SA, VanderWeele, DJ, Harmon, S, Bloom, JB, Karzai, F, Hale, GR, Marhamati, S, Rayn, KN, Mehralivand, S, Merino, MJ, Gulley, JL, Bilusic, M, Madan, RA, Choyke, PL, Turkbey, B, Dahut, W & Pinto, PA 2019, 'mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy', Urologic Oncology: Seminars and Original Investigations, vol. 37, no. 6, pp. 352.e25-352.e30. https://doi.org/10.1016/j.urolonc.2019.01.012

TY - JOUR

T1 - mpMRI preoperative staging in men treated with antiandrogen and androgen deprivation therapy before robotic prostatectomy

AU - Gold, Samuel A.

AU - VanderWeele, David James

AU - Harmon, Stephanie

AU - Bloom, Jonathan B.

AU - Karzai, Fatima

AU - Hale, Graham R.

AU - Marhamati, Shawn

AU - Rayn, Kareem N.

AU - Mehralivand, Sherif

AU - Merino, Maria J.

AU - Gulley, James L.

AU - Bilusic, Marijo

AU - Madan, Ravi A.

AU - Choyke, Peter L.

AU - Turkbey, Baris

AU - Dahut, William

AU - Pinto, Peter A.

PY - 2019/6

Y1 - 2019/6

N2 - Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.

AB - Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.

KW - Androgen deprivation

KW - Enzalutamide

KW - Multiparametric MRI

KW - Prostate cancer

UR - http://www.scopus.com/inward/record.url?scp=85065127194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065127194&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2019.01.012

DO - 10.1016/j.urolonc.2019.01.012

M3 - Article

C2 - 31000430

AN - SCOPUS:85065127194

SN - 1078-1439

VL - 37

SP - 352.e25-352.e30

JO - Urologic Oncology: Seminars and Original Investigations

JF - Urologic Oncology: Seminars and Original Investigations

IS - 6

ER -

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this