title: Tumor staging using 3.0 T multiparametric MRI in prostate cancer: impact on treatment decisions for radical radiotherapy.
abstract: To assess and validate the incorporation of the multiparametric magnetic resonance imaging (mpMRI) tumour category (mT-category) to the conventional clinical tumour category (cT-category), in order to guide the radiotherapy (RT) treatment decisions in prostate cancer. In addition, to identify the clinical factors associated to the technique reliability. mpMRI was performed in 274 prostate cancer patients in order to refine the treatment decisions according to PSA, Gleason Score (GS) and cT-category. Comparisons between the cT and mT-category were performed, as well as the impact on the RT treatment [target volume, doses and hormonal therapy (HT)] independently if it was finally performed. Changes in HT indication for intermediate risk were also analyzed. mpMRI validation was performed with pathological staging (n = 90 patients finally decided to join surgery). The mpMRI upstaging range was 86-94 % for any PSA value or GS. Following mpMRI, 32.8 % of the patients (90/274) were assigned to a different risk group. Compared to cT-category, mpMRI identified more intermediate-risk (46.4 vs. 59.5 %) and high-risk (19.0 vs. 28.8 %) prostate cancer patients. This resulted in a higher indication (p < 0.05) of seminal vesicle irradiation (63.5 vs. 70.0 %), inclusion of any extracapsular disease (T3-T4) within the target volume (1.8 vs. 18.2 %), higher doses (65.3 vs. 88.3 %) and HT associated to RT (45.6 vs. 62.4 %). Global accuracy for mpMRI was higher compared to DRE/TRUS (8.9 vs. 71.1 %, p < 0.05). mpMRI reliability was independent of PSA or GS. mpMRI tumor staging significantly modified the RT treatment decisions in all prostate cancer risk groups.
authors.affiliation: Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Couñago
authors.affiliation: Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain.
authors.forename: Elia
authors.initials: E
authors.lastname: Del Cerro
authors.affiliation: Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain.
authors.forename: Ana Aurora
authors.initials: AA
authors.lastname: Díaz-Gavela
authors.affiliation: Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, Pozuelo de Alarcón, 28223 Madrid, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Marcos
authors.affiliation: Department of Radiology, Hospital Universitario Quiron, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Recio
authors.affiliation: Clinical Department, School of Biomedical Sciences, Universidad Europea, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Sanz-Rosa
authors.affiliation: School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain.
authors.forename: Israel
authors.initials: I
authors.lastname: Thuissard
authors.affiliation: School of Biomedical Sciences, Universidad Europea, Madrid, Spain.
authors.forename: Karmele
authors.initials: K
authors.lastname: Olaciregui
authors.affiliation: Hospital Universitario Quiron, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Mateo
authors.affiliation: Departament of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Cerezo
keywords: Multiparametric MRI; Prostate cancer; Radiotherapy; Staging