Evaluating the potential benefit of reduced planning target volume margins for low and intermediate risk patients with prostate cancer using real-time electromagnetic tracking

Background To investigate whether magnetic resonance (MR) radiomic features combined with machine learning may aid in predicting extraprostatic extension (EPE) in high- and non-favorable intermediate-risk patients with prostate cancer. Purpose To investigate the diagnostic performance of radiomics to detect EPE. Material and Methods MR radiomic features were extracted from 228 patients, of whom 86 were diagnosed with EPE, using prostate and lesion segmentations. Prediction models were built using Random Forest. Further, EPE was also predicted using a clinical nomogram and routine radiological interpretation and diagnostic performance was assessed for individual and combined models. Results The MR radiomic model with features extracted from the manually delineated lesions performed best among the radiomic models with an area under the curve (AUC) of 0.74. Radiology interpretation yielded an AUC of 0.75 and the clinical nomogram (MSKCC) an AUC of 0.67. A combination of the three prediction models gave the highest AUC of 0.79. Conclusion Radiomic analysis combined with radiology interpretation aid the MSKCC nomogram in predicting EPE in high- and non-favorable intermediate-risk patients.

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Tailored therapy in prostate cancer is the “new era”: Retrospective, monocentric Italian analysis between radiotherapy cyber-knife versus robot assisted radical prostatectomy in low-intermediate risk patients

European Urology Open Science ◽

10.1016/s2666-1683(20)30051-3 ◽

2020 ◽

Vol 19 ◽

pp. e57

Author(s):

M. Bada ◽

B. De Concilio ◽

G. Zeccolini ◽

G. Mazzon ◽

M. Justich ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Intermediate Risk ◽

Robot Assisted ◽

Tailored Therapy ◽

New Era ◽

Risk Patients

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WE-AB-207B-09: Margin Reduction for Planning Target Volume (PTV) in Patients with Localized Prostate Cancer: Impact On Delivered Dose and Quality of Life

Medical Physics ◽

10.1118/1.4957790 ◽

2016 ◽

Vol 43 (6Part39) ◽

pp. 3806-3806

Author(s):

A Kumarasiri ◽

C Liu ◽

S Brown ◽

C Glide-Hurst ◽

M Elshaikh ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Planning Target Volume ◽

Target Volume ◽

Localized Prostate Cancer ◽

Delivered Dose

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Rectal spacer hydrogel in 1.5T MR-guided and daily adapted SBRT for prostate cancer: dosimetric analysis and preliminary patient-reported outcomes

British Journal of Radiology ◽

10.1259/bjr.20200848 ◽

2021 ◽

Vol 94 (1117) ◽

pp. 20200848

Author(s):

Filippo Alongi ◽

Michele Rigo ◽

Vanessa Figlia ◽

Francesco Cuccia ◽

Niccolò Giaj-Levra ◽

...

Keyword(s):

Prostate Cancer ◽

Planning Target Volume ◽

Patient Reported Outcomes ◽

Target Volume ◽

Spacer Group ◽

End Of Treatment ◽

Patient Reported ◽

Eortc Qlq C30 ◽

Dosimetric Analysis ◽

Eortc Qlq

Objective: The main aim of the current analysis was to explore the hypothetical advantages using rectal spacer during 1.5T MR-guided and daily adapted prostate cancer stereotactic body radiotherapy (SBRT) compared to a no-rectal spacer hydrogel cohort of patients. Methods: The SBRT-protocol consisted of a 35 Gy schedule delivered in 5 fractions. Herein, we present a dosimetric analysis between spacer and no-spacer patients. Furthermore, treatment tolerability and feasibility were preliminarily assessed according to clinicians-reported outcomes at the end of treatment and patient-reported outcomes measures (PROMs) in both arms. Toxicity and quality of life were assessed at baseline and after treatment using the Common Terminology Criteria for Adverse Events v. 5.0, International Prostatic Symptoms Score, ICIQ-SF, IIEF-5, and EORTC-QLQ-C30 and PR-25 questionnaires. Results: 120 plans (pre- and daily adaptive SBRT planning) were analyzed in 20 patients (10 patients in spacer group and 10 patients in no-spacer group) treated using 1.5T MR-guided adaptive SBRT. Statistically significant dosimetric advantages were observed in favor of the spacer insertion, improving the planning target volume coverage in terms of V33.2Gy >95% and planning target volume 37.5 Gy <2% mainly during daily-adapted SBRT. Also, rectum V32, V28 and V18Gy and bladder V35Gy <1 cc were significantly reduced in the spacer cohort. Concerning the PROMS, all questionnaires showed no difference between the pre- and post-SBRT evaluation in both arms, excepting the physical functioning item of EORTC QLQ-C30 questionnaire that was declined in the no-spacer group. Conclusion: These preliminary results strongly suggest the adoption of perirectal spacer due to dosimetric advantages not only for rectal sparing but also for target coverage. Longer follow-up is required to validate the clinical impact in terms of clinicians-reported toxicity and PROMs. Advances in knowledge: This the first experience reporting preliminary data concerning the potential dosimetric impact of rectal hydrogel spacer on MR-guided SBRT for prostate cancer.

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Clinical Utility of the Percentage of Positive Prostate Biopsies in Defining Biochemical Outcome After Radical Prostatectomy for Patients With Clinically Localized Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.6.1164 ◽

2000 ◽

Vol 18 (6) ◽

pp. 1164-1172 ◽

Cited By ~ 229

Author(s):

Anthony V. D’Amico ◽

Richard Whittington ◽

S. Bruce Malkowicz ◽

Delray Schultz ◽

Julia Fondurulia ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Clinical Utility ◽

Localized Prostate Cancer ◽

Intermediate Risk ◽

Prostate Biopsies ◽

Psa Failure ◽

Surgical Data ◽

Risk Patients ◽

Clinically Significant

PURPOSE: To determine the clinical utility of the percentage of positive prostate biopsies in predicting prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for men with PSA-detected or clinically palpable prostate cancer. METHODS: A Cox regression multivariable analysis was used to determine whether the percentage of positive prostate biopsies provided clinically relevant information about PSA outcome after RP in 960 men while accounting for the previously established risk groups that are defined according to pretreatment PSA level, biopsy Gleason score, and the 1992 American Joint Committee on Cancer (AJCC) clinical T stage. The findings were then tested using an independent surgical database that included data for 823 men. RESULTS: Controlling for the known prognostic factors, the percentage of positive prostate biopsies added clinically significant information (P < .0001) regarding time to PSA failure after RP. Specifically, 80% of the patients in the intermediate-risk group (1992 AJCC T2b, or biopsy Gleason 7 or PSA > 10 ng/mL and ≤ 20 ng/mL) could be classified into either an 11% or 86% 4-year PSA control cohort using the preoperative prostate biopsy data. These findings were validated in the intermediate-risk patients using an independent surgical data set. CONCLUSION: The validated stratification of PSA outcome after RP using the percentage of positive prostate biopsies in intermediate-risk patients is clinically significant. This information can be used to identify men with newly diagnosed and clinically localized prostate cancer who are at high risk for early (≤ 2 years) PSA failure and, therefore, may benefit from the use of adjuvant therapy.

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