title: Prostate MRSI predicts outcome in radical prostatectomy patients.
abstract: New non-invasive methods are needed for sub-stratifying high-risk prostate cancer patients. Magnetic resonance spectroscopic imaging (MRSI) maps metabolites in prostate cancer, providing information on tumor aggressiveness and volume.
  
  
  
  To investigate the correlation between MRSI and treatment failure (TF) after radical prostatectomy (RP).
  
  
  
  Two-hundred sixty-two patients who underwent endorectal MRI/MRSI followed by RP at our institution from 2003 to 2007 were studied. MRI stage, number of voxels in the MRSI index lesion (NILV), number of high-grade voxels (NHGV), and number of voxels containing undetectable polyamines (NUPV) were derived. Clinical outcome was followed until August, 2014. Treatment failure was defined as 1) biochemical recurrence (BCR), 2) persistently detectable PSA after RP, or 3) adjuvant therapy initiated in the absence of BCR. MRI/MRSI features and clinical parameters were compared to TF by univariate Cox Proportional Hazards Regression. After backward selection, each MRSI parameter was included in a separate regression model adjusted for NCCN-based clinical risk score (CRS), number of biopsy cores positive (NPC), and MRI stage.
  
  
  
  In univariate analysis, all clinical variables were associated with TF in addition to MRI stage, NILV, NHGV, and NUPV. In multivariate analysis, NILV, NHGV, and NUPV were also significant risk factors for TF (p=0.016, p=0.002, p=0.006, respectively). The association between the number of tumor voxels with undetectable polyamines and the probability of treatment failure has not been previously reported. The number of MRSI cancer voxels correlated with extracapsular extension (ECE) (p<0.0001).
  
  
  
  MRSI was associated with post-radical prostatectomy treatment failure in models adjusted for the number of positive biopsy cores and clinical risk score. This is the first report that in radical prostatectomy patients MRSI has an association with treatment failure independent of the number of positive biopsy cores. MRSI may help the clinician determine whether patients with high risk disease who undergo RP are candidates for specialized additional treatment.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: zakiank@mskcc.org.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Zakian
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: wnhat1@student.monash.edu.
authors.forename: William
authors.initials: W
authors.lastname: Hatfield
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: araso@mskcc.org.
authors.forename: Omer
authors.initials: O
authors.lastname: Aras
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: kun-cao@hotmail.com.
authors.forename: Kun
authors.initials: K
authors.lastname: Cao
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: derya.yakar@radboudumc.nl.
authors.forename: Derya
authors.initials: D
authors.lastname: Yakar
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: goldmand@mskcc.org.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldman
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: moskowc1@mskcc.org.
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: davea@mskcc.org.
authors.forename: Amita
authors.initials: A
authors.lastname: Shukla-Dave
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: mazahery@mskcc.org.
authors.forename: Yousef Mazaheri
authors.initials: YM
authors.lastname: Tehrani
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: fines@mskcc.org.
authors.forename: Samson
authors.initials: S
authors.lastname: Fine
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: easthamj@mskcc.org.
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.affiliation: MSKCC, 1275 York Avenue, NY, NY, 10065, USA. Electronic address: hricakh@mskcc.org.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Choline; Gleason score; MRI; MRSI; Prostate cancer; Spectroscopy
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