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• W1995637057 abstract "Purpose/Objective(s)The delivery of high doses of radiation to the entire prostate bed is somewhat limited due to the presence of the bladder and rectum. Dose escalation data in the post-prostatectomy setting suggests that local control is suboptimal and related to tumor burden. If regions in the prostate bed could be identified, then higher than standard doses could be directed to the smaller volumes with less potential long term morbidity. DCE MRI can be utilized to identify tumor associated new angiogenic blood vessels. This has been shown to have a higher sensitivity than T2 weighted MRI images alone. We applied this technology to 34 men with an elevated PSA after radical surgery and evaluated enhancement patterns to identify residual or recurrent disease.Materials/Methods33 patients who were referred for RT consultation at the University of Miami from 6/1/2008 to 1/21/2011 were prospectively evaluated. The DCE-MRI data were acquired on a 3T MR scanner (Siemens Trio Tim, Erlangen, Germany). T2 and T1 MR images were acquired prior to contrast material injection followed by 11-12 post-contrast image sets. The DCE data were analyzed with in-house software, utilizing pattern recognition techniques for deconvolution of the contrast-to-time patterns. Identified areas in the prostate bed were scored as positive only if there was early contrast wash in and then wash-out in a characteristic pattern.ResultsOut of the 33 pts, 14 (42%) were positive in the prostate bed. The median age of the patients presenting for RT was 63 years (43 - 79). Nine patients (26%) had a prostatectomy Gleason Score (GS) of 6, 13 (38%) had a GS of 7, 7 (20%) had a GS of 8, and 5 (15%) had a GS of 9. The average pre-RT PSA was 1.16 (0.1 - 9.2); 0.96 (median 0.33) for MRI (-) Pts and 1.8 (median 0.5) for MRI (+). For MRI (-) pts the median interval between surgery and radiation was 2.7 yrs and 2.54 yrs for MRI (+). Of the MRI(+) pts 6 (43%) were T2, 5 (36%) T3a, 2 (14%)T3b and 1 (7%) T4. Of the MRI(-) pts 11 (58%) were T2, 4 (21%) T3a, 4 (21%)T3b and 0 (0%) T4. Due to small numbers these differences were not statistically significant.ConclusionsOur data indicate that MRI, combined with DCE detects abnormalities suggestive of residual tumor in the prostate bed in 42% of patients evaluated for RT. This suggests a substantial amount of disease for which standard doses of salvage radiation may be inadequate. By limiting the high dose of radiation only to the gross disease, we may improve our therapeutic index. Purpose/Objective(s)The delivery of high doses of radiation to the entire prostate bed is somewhat limited due to the presence of the bladder and rectum. Dose escalation data in the post-prostatectomy setting suggests that local control is suboptimal and related to tumor burden. If regions in the prostate bed could be identified, then higher than standard doses could be directed to the smaller volumes with less potential long term morbidity. DCE MRI can be utilized to identify tumor associated new angiogenic blood vessels. This has been shown to have a higher sensitivity than T2 weighted MRI images alone. We applied this technology to 34 men with an elevated PSA after radical surgery and evaluated enhancement patterns to identify residual or recurrent disease. The delivery of high doses of radiation to the entire prostate bed is somewhat limited due to the presence of the bladder and rectum. Dose escalation data in the post-prostatectomy setting suggests that local control is suboptimal and related to tumor burden. If regions in the prostate bed could be identified, then higher than standard doses could be directed to the smaller volumes with less potential long term morbidity. DCE MRI can be utilized to identify tumor associated new angiogenic blood vessels. This has been shown to have a higher sensitivity than T2 weighted MRI images alone. We applied this technology to 34 men with an elevated PSA after radical surgery and evaluated enhancement patterns to identify residual or recurrent disease. Materials/Methods33 patients who were referred for RT consultation at the University of Miami from 6/1/2008 to 1/21/2011 were prospectively evaluated. The DCE-MRI data were acquired on a 3T MR scanner (Siemens Trio Tim, Erlangen, Germany). T2 and T1 MR images were acquired prior to contrast material injection followed by 11-12 post-contrast image sets. The DCE data were analyzed with in-house software, utilizing pattern recognition techniques for deconvolution of the contrast-to-time patterns. Identified areas in the prostate bed were scored as positive only if there was early contrast wash in and then wash-out in a characteristic pattern. 33 patients who were referred for RT consultation at the University of Miami from 6/1/2008 to 1/21/2011 were prospectively evaluated. The DCE-MRI data were acquired on a 3T MR scanner (Siemens Trio Tim, Erlangen, Germany). T2 and T1 MR images were acquired prior to contrast material injection followed by 11-12 post-contrast image sets. The DCE data were analyzed with in-house software, utilizing pattern recognition techniques for deconvolution of the contrast-to-time patterns. Identified areas in the prostate bed were scored as positive only if there was early contrast wash in and then wash-out in a characteristic pattern. ResultsOut of the 33 pts, 14 (42%) were positive in the prostate bed. The median age of the patients presenting for RT was 63 years (43 - 79). Nine patients (26%) had a prostatectomy Gleason Score (GS) of 6, 13 (38%) had a GS of 7, 7 (20%) had a GS of 8, and 5 (15%) had a GS of 9. The average pre-RT PSA was 1.16 (0.1 - 9.2); 0.96 (median 0.33) for MRI (-) Pts and 1.8 (median 0.5) for MRI (+). For MRI (-) pts the median interval between surgery and radiation was 2.7 yrs and 2.54 yrs for MRI (+). Of the MRI(+) pts 6 (43%) were T2, 5 (36%) T3a, 2 (14%)T3b and 1 (7%) T4. Of the MRI(-) pts 11 (58%) were T2, 4 (21%) T3a, 4 (21%)T3b and 0 (0%) T4. Due to small numbers these differences were not statistically significant. Out of the 33 pts, 14 (42%) were positive in the prostate bed. The median age of the patients presenting for RT was 63 years (43 - 79). Nine patients (26%) had a prostatectomy Gleason Score (GS) of 6, 13 (38%) had a GS of 7, 7 (20%) had a GS of 8, and 5 (15%) had a GS of 9. The average pre-RT PSA was 1.16 (0.1 - 9.2); 0.96 (median 0.33) for MRI (-) Pts and 1.8 (median 0.5) for MRI (+). For MRI (-) pts the median interval between surgery and radiation was 2.7 yrs and 2.54 yrs for MRI (+). Of the MRI(+) pts 6 (43%) were T2, 5 (36%) T3a, 2 (14%)T3b and 1 (7%) T4. Of the MRI(-) pts 11 (58%) were T2, 4 (21%) T3a, 4 (21%)T3b and 0 (0%) T4. Due to small numbers these differences were not statistically significant. ConclusionsOur data indicate that MRI, combined with DCE detects abnormalities suggestive of residual tumor in the prostate bed in 42% of patients evaluated for RT. This suggests a substantial amount of disease for which standard doses of salvage radiation may be inadequate. By limiting the high dose of radiation only to the gross disease, we may improve our therapeutic index. Our data indicate that MRI, combined with DCE detects abnormalities suggestive of residual tumor in the prostate bed in 42% of patients evaluated for RT. This suggests a substantial amount of disease for which standard doses of salvage radiation may be inadequate. By limiting the high dose of radiation only to the gross disease, we may improve our therapeutic index." @default.
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• W1995637057 date "2011-10-01" @default.
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• W1995637057 title "Dynamic Contrast Enhanced MRI for the Identification of Prostate Cancer in the Prostate Bed After Radical Prostatectomy" @default.
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