Tumor characteristics of multiparametric MRI-detected and -undetected lesions in patients with suspected radiorecurrent prostate cancer: An analysis from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial

You have accessJournal of UrologyCME1 Apr 2023MP44-06 TUMOR CHARACTERISTICS OF MULTIPARAMETRIC MRI-DETECTED AND -UNDETECTED LESIONS IN PATIENTS WITH SUSPECTED RADIORECURRENT PROSTATE CANCER: AN ANALYSIS FROM THE FOCAL RECURRENT ASSESSMENT AND SALVAGE TREATMENT (FORECAST) TRIAL Alexander Light, Abi Kanthabalan, Menelaos Pavlou, Rumana Omar, Sola Adeleke, Francesco Giganti, Chris Brew-Graves, Amr Emara, Athar Haroon, Arash Latifoltojar, Harbir Sidhu, Alex Freeman, Clement Orczyk, Ashok Nikapota, Tim Dudderidge, Richard G. Hindley, Heather Payne, Anita Mitra, Jamshed Bomanji, Mathias Winkler, Gail Horan, Shonit Punwani, Hashim U. Ahmed, and Taimur T. Shah Alexander LightAlexander Light More articles by this author , Abi KanthabalanAbi Kanthabalan More articles by this author , Menelaos PavlouMenelaos Pavlou More articles by this author , Rumana OmarRumana Omar More articles by this author , Sola AdelekeSola Adeleke More articles by this author , Francesco GigantiFrancesco Giganti More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , Amr EmaraAmr Emara More articles by this author , Athar HaroonAthar Haroon More articles by this author , Arash LatifoltojarArash Latifoltojar More articles by this author , Harbir SidhuHarbir Sidhu More articles by this author , Alex FreemanAlex Freeman More articles by this author , Clement OrczykClement Orczyk More articles by this author , Ashok NikapotaAshok Nikapota More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Richard G. HindleyRichard G. Hindley More articles by this author , Heather PayneHeather Payne More articles by this author , Anita MitraAnita Mitra More articles by this author , Jamshed BomanjiJamshed Bomanji More articles by this author , Mathias WinklerMathias Winkler More articles by this author , Gail HoranGail Horan More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Hashim U. AhmedHashim U. Ahmed More articles by this author , and Taimur T. ShahTaimur T. Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The interpretation of multiparametric MRI (mpMRI) post-radiotherapy can be challenging due to factors like glandular atrophy and diffuse T2 low signal. Using data from the FORECAST paired validation study, we compared the characteristics of mpMRI-detected and -undetected radiorecurrent disease. METHODS: The prospective FORECAST study (NCT01883128) recruited men from 6 UK centers with suspected radiorecurrent cancer who underwent prostate mpMRI followed by systematic transperineal template mapping and MRI-targeted biopsies. MRI visibility was defined as a Likert score 3-5. 3 cancer definitions were studied: any cancer; Grade Group ≥3 and/or maximum cancer core length (MCCL) ≥6mm (PROMIS definition 1); and Grade Group ≥2 and/or MCCL ≥4mm (PROMIS definition 2). Characteristics of MRI-detected vs -undetected tumors were compared. Analyses were performed at the prostate quadrant level using cluster bootstrapping with 10,000 resamples. RESULTS: 578 quadrants (147 men) were included. 88/261 quadrants (33.7%) with any cancer were MRI-undetected, compared to 62/198 quadrants (31.3%) for definition 1, and 80/238 quadrants (33.6%) for definition 2. Sensitivity of MRI for any cancer was 0.66 (95%CI 0.60-0.73), comparable to definition 1 (0.69, 95%CI 0.61-0.76) and definition 2 (0.66, 95%CI 0.60-0.73). Specificity was poorer (any cancer 0.54, 95%CI 0.46-0.62; definition 1: 0.54, 95%CI 0.46-0.62; definition 2: 0.54, 95%CI 0.46-0.62;). MRI-detected cancer comprised more Grade Group 5 tumors (difference 13.5%, p=0.01) (Table 1). MRI-detected tumors also had longer MCCL (median difference 3mm, p<0.001), and yielded more positive cores (median difference 2 cores, p=0.003). CONCLUSIONS: Of mpMRI-undetected tumors, there were fewer Grade Group 5 tumors, MCCL was shorter, and number of positive cores were fewer. At the prostate quadrant level, mpMRI had modest sensitivity and specificity, and may miss over 30% of radiorecurrent tumors across cancer definitions. mpMRI alone is therefore insufficient in localizing radiorecurrent prostate cancer. Source of Funding: Funded by the Pelican Cancer Foundation, the US National Institutes of Health, and the UK Medical Research Council © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e612 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Light More articles by this author Abi Kanthabalan More articles by this author Menelaos Pavlou More articles by this author Rumana Omar More articles by this author Sola Adeleke More articles by this author Francesco Giganti More articles by this author Chris Brew-Graves More articles by this author Amr Emara More articles by this author Athar Haroon More articles by this author Arash Latifoltojar More articles by this author Harbir Sidhu More articles by this author Alex Freeman More articles by this author Clement Orczyk More articles by this author Ashok Nikapota More articles by this author Tim Dudderidge More articles by this author Richard G. Hindley More articles by this author Heather Payne More articles by this author Anita Mitra More articles by this author Jamshed Bomanji More articles by this author Mathias Winkler More articles by this author Gail Horan More articles by this author Shonit Punwani More articles by this author Hashim U. Ahmed More articles by this author Taimur T. Shah More articles by this author Expand All Advertisement PDF downloadLoading ...