Predicting Biochemical Failure in Irradiated Patients With Prostate Cancer by Tumour Volume Measured by Multiparametric MRI

Background/aim: We examined the prognostic value of intraprostatic gross tumour volume (GTV) as measured by multiparametric MRI (mpMRI) in patients with prostate cancer following (primary) external beam radiation therapy (EBRT).

Patients and methods: In a retrospective monocentric study, we analysed patients with prostate cancer (PCa) after EBRT. GTV was delineated in pre-treatment mpMRI (GTV-MRI) using T2-weighted images. Cox-regression analyses were performed considering biochemical failure recurrence-free survival (BRFS) as outcome variable.

Results: Among 131 patients, after a median follow-up of 57 months, biochemical failure occurred in 27 (21%). GTV-MRI was not correlated with % of positive biopsy cores, Gleason score and initial PSA (all r<0.2) and only moderately correlated with cT stage (r=0.32). In univariate analysis, cT stage, Gleason score and GTV-MRI were higher in subjects with shorter BRFS (p<0.05). GTV-MRI remained a significant predictor for BRFS in multivariate analyses, independent of Gleason score and cT stage.

Conclusion: GTV, defined using mpMRI, provides incremental prognostic value for BRFS, independent of established risk factors. This supports the implementation of imaging-based GTV for risk-stratification, although further validation is needed.