Is prospective MRI mapping of the changes in the volume of the prostate gland in prostate cancer patients undergoing 6 months of neo-adjuvant androgen deprivation therapy a step towards a trial to determine those who may benefit from treatment intensification or extended duration?

Long-term oncological outcomes after multimodal treatment for locally advanced prostate cancer

Objective

The aim of this study is to evaluate treatment patterns and long-term oncological outcomes of patients with locally advanced prostate cancer (LAPCa).

Patients and methods

This is a population-based study including LAPC (cT3-4, M0) patients from the Stockholm region (Sweden). A sub-analysis was performed in men treated with primary cystoprostatectomy or total pelvic exenteration (TPE) for cT4 prostate cancer (PCa).Cox regression was used to identify predictors of overall mortality (OM) and cancer-specific mortality (CSM). Biochemical progression-free survival (BPFS) and 90 days complications were reported for the radical surgery subgroup.

Results

We included 2921 patients with cT3(N = 2713) or cT4(N = 208), M0 PCa diagnosed between 2003 and 2019. Out of these, 249(9%), 1497(51%) and 1175(40%) underwent radical prostatectomy, RT + ADT and androgen deprivation therapy (ADT), respectively. Survival rates were 76% (IQR: 68, 83), 47% (IQR: 44, 50) and 23% (IQR: 20, 27), respectively at 10 years. Irrespective of treatment modalities, cT4 patients had worse survival compared to cT3 patients (OM: HR1.44, IQR:1.17,1.77; PCSM: HR1.39, IQR:1.06,1.82). Twenty-seven patients with cT4, N0-1, M0 were treated with cystoprostatectomy or TPE. Twenty-two patients (81.5%) received neoadjuvant ADT. The 5-year BPFS, CSS and OS rates were 39.6%, 68.8% and 63.8%, respectively. Nine patients (33.3%) had Clavien-Dindo grade III and 1 (3.7%) grade IV complication within 90 days after surgery.

Conclusions

Pelvic surgery with radical intent as part of a multidisciplinary management may be an effective alternative for selected patients with locally advanced PCa leading to local tumour control and an acceptable morbidity.

The clinical guiding value of a radiomics model for androgen deprivation therapy for prostate cancer

OBJECTIVE

Three models were used to evaluate prostate cancer after androgen deprivation therapy (ADT) and to determine the value of detecting residual lesions after treatment.

METHODS

We retrospectively analysed patients with prostate cancer who received ADT from January 2018 to June 2019. Patients were divided into ADT responder and ADT non-responder groups, and clinical risk factors were determined. Regions of interest were manually contoured on each slice on fat-saturated-T2-weighted imaging, and radiomic features were extracted. Uni- and multivariate logistic regression were used to establish radiomics, clinical and combined models.

RESULTS

There were 23 ADT non-responders and 20 ADT responders. In the clinical model, total prostate-specific antigen concentration and T stage were independent predictors of efficacy (area under the curve (AUC) = 0.774). The characteristics, MinIntensity and Correlation_ angle135_offset4 indicated an effective clinical model (AUC = 0.807). GLCMEntropy_ AllDirection_offset1_SD was the best feature to differentiate residual lesions from the central gland (CG) (Lesion-CG model, AUC = 0.955). Correlation_angle135_offset4, GLCMEntropy_ AllDirection_offset4_SD and GLCMEntropy_AllDirection_offset7_SD differentiated residual lesions from the peripheral zone (PZ) (Lesion-PZ model, AUC = 0.855). The AUC for the combined model was 0.904.

CONCLUSIONS

Our models can guide the clinical treatment of patients with different ADT responses. Furthermore, the radiomics model can detect prostate cancer that is non-responsive to ADT.