Whole body MRI (WB-MRI) assessment of metastatic spread in prostate cancer: Therapeutic perspectives on targeted management of oligometastatic disease

OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion‐weighted imaging (WB‐MRI/DWI). To determine the proportion of patients with nodal disease confined within currentl...

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Published inThe Prostate Vol. 76; no. 11; pp. 1024 - 1033
Main Authors Larbi, Ahmed, Dallaudière, Benjamin, Pasoglou, Vasiliki, Padhani, Anwar, Michoux, Nicolas, Vande Berg, Bruno C., Tombal, Bertrand, Lecouvet, Frédéric E.
Format Journal Article
LanguageEnglish
Published United States Blackwell Publishing Ltd 01.08.2016
Wiley Subscription Services, Inc
Subjects
Aged
bone
Bone Neoplasms - diagnostic imaging
Bone Neoplasms - secondary
Cancer therapies
Humans
Lymph Node Excision
lymph nodes
Lymph Nodes - pathology
Lymphatic Metastasis - diagnostic imaging
Magnetic Resonance Imaging
Male
metastases
Metastasis
Middle Aged
MRI
Neoplasm Metastasis - diagnostic imaging
NMR
Nuclear magnetic resonance
oligometastasis
Prostate cancer
Prostatectomy
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - therapy
Radiotherapy
Viscera - diagnostic imaging
Whole Body Imaging
metastases
lymph nodes
MRI
prostate-cancer
radiotherapy
bone
oligometastasis
Online AccessGet full text
ISSN0270-4137
1097-0045
1097-0045
DOI10.1002/pros.23196

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Abstract OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion‐weighted imaging (WB‐MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT). SUBJECTS AND METHODS Two radiologists reviewed WB‐MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non‐metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined. RESULTS Twenty‐eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with ≤3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para‐aortic, inter‐aortico‐cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only ≤25% and ≤30% of patients, respectively. CONCLUSIONS Non‐invasive mapping of metastatic landing sites in PCa using WB‐MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high‐risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024–1033, 2016. © 2016 Wiley Periodicals, Inc.
AbstractList OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease ( less than or equal to 3 synchronous lesions) using whole body magnetic resonance imaging with diffusion-weighted imaging (WB-MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT). SUBJECTS AND METHODS Two radiologists reviewed WB-MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non-metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined. RESULTS Twenty-eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with less than or equal to 3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para-aortic, inter-aortico-cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only less than or equal to 25% and less than or equal to 30% of patients, respectively. CONCLUSIONS Non-invasive mapping of metastatic landing sites in PCa using WB-MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high-risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024-1033, 2016.
OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion-weighted imaging (WB-MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT). SUBJECTS AND METHODS Two radiologists reviewed WB-MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non-metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined. RESULTS Twenty-eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with ≤3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para-aortic, inter-aortico-cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only ≤25% and ≤30% of patients, respectively. CONCLUSIONS Non-invasive mapping of metastatic landing sites in PCa using WB-MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high-risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024-1033, 2016. © 2016 Wiley Periodicals, Inc.
OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion‐weighted imaging (WB‐MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT). SUBJECTS AND METHODS Two radiologists reviewed WB‐MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non‐metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined. RESULTS Twenty‐eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with ≤3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para‐aortic, inter‐aortico‐cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only ≤25% and ≤30% of patients, respectively. CONCLUSIONS Non‐invasive mapping of metastatic landing sites in PCa using WB‐MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high‐risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024–1033, 2016. © 2016 Wiley Periodicals, Inc.
To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion-weighted imaging (WB-MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT). Two radiologists reviewed WB-MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non-metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined. Twenty-eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with ≤3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para-aortic, inter-aortico-cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only ≤25% and ≤30% of patients, respectively. Non-invasive mapping of metastatic landing sites in PCa using WB-MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high-risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024-1033, 2016. © 2016 Wiley Periodicals, Inc.
To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion-weighted imaging (WB-MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT).OBJECTIVESTo determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging with diffusion-weighted imaging (WB-MRI/DWI). To determine the proportion of patients with nodal disease confined within currently accepted target areas for extended lymph node dissection (eLND) and pelvic external beam radiation therapy (EBRT).Two radiologists reviewed WB-MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non-metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined.SUBJECTS AND METHODSTwo radiologists reviewed WB-MRI/DWI studies in 96 consecutive newly diagnosed metastatic PCa patients; 46 patients with newly diagnosed castration naive PCa (mHNPC) and 50 patients with first appearance of metastasis during monitoring for non-metastatic castration resistant PCa (M0 to mCRPC). The distribution of metastatic deposits was assessed and the proportions of patients with oligometastatic disease and with LN metastases located within eLND and EBRT targets were determined.Twenty-eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with ≤3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para-aortic, inter-aortico-cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only ≤25% and ≤30% of patients, respectively.RESULTSTwenty-eight percent of mHNPC and 50% of mCPRC entered the metastatic disease with ≤3 sites. Bone metastases (BM) were identified in 68.8% patients; 71.7% of mHNPC and 66% mCRPC patients. Most commonly involved areas were iliac bones and lumbar spine. Enlarged lymph nodes (LN) were detected in 68.7% of patients; 69.6% of mHNPC and 68.0% of mCRPC. Most commonly involved areas were para-aortic, inter-aortico-cava, and external iliac areas. BM and LN were detected concomitantly in 41% of mHNPC and 34% of mCRPC. Visceral metastases were detected in 6.7%. Metastatic disease was confined to LN located within the accepted boundaries of eLND or pelvic EBRT target areas in only ≤25% and ≤30% of patients, respectively.Non-invasive mapping of metastatic landing sites in PCa using WB-MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high-risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024-1033, 2016. © 2016 Wiley Periodicals, Inc.CONCLUSIONSNon-invasive mapping of metastatic landing sites in PCa using WB-MRI/DWI shows that 28% of the mHNPC patients, and 52% of the mCRPC can be classified as oligometastatic, thus challenging the concept of metastatic targeted therapy. More than two thirds of metastatic patients have LN located outside the usually recommended targets of eLND and pelvic EBRT. Prophylactic or salvage treatments of these sole areas in patients with high-risk prostate cancer may not prevent the emergence of subsequent metastases. Prostate 76:1024-1033, 2016. © 2016 Wiley Periodicals, Inc.
Author Lecouvet, Frédéric E.
Larbi, Ahmed
Vande Berg, Bruno C.
Dallaudière, Benjamin
Michoux, Nicolas
Pasoglou, Vasiliki
Tombal, Bertrand
Padhani, Anwar
Author_xml – sequence: 1
  givenname: Ahmed
  surname: Larbi
  fullname: Larbi, Ahmed
  organization: Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
– sequence: 2
  givenname: Benjamin
  surname: Dallaudière
  fullname: Dallaudière, Benjamin
  organization: Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
– sequence: 3
  givenname: Vasiliki
  surname: Pasoglou
  fullname: Pasoglou, Vasiliki
  organization: Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
– sequence: 4
  givenname: Anwar
  surname: Padhani
  fullname: Padhani, Anwar
  organization: Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, Northwood, United Kingdom
– sequence: 5
  givenname: Nicolas
  surname: Michoux
  fullname: Michoux, Nicolas
  organization: Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
– sequence: 6
  givenname: Bruno C.
  surname: Vande Berg
  fullname: Vande Berg, Bruno C.
  organization: Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
– sequence: 7
  givenname: Bertrand
  surname: Tombal
  fullname: Tombal, Bertrand
  organization: Urology Unit, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
– sequence: 8
  givenname: Frédéric E.
  surname: Lecouvet
  fullname: Lecouvet, Frédéric E.
  email: Correspondence to: Prof. Frederic Lecouvet, Service de Radiologie, Cliniques universitaires Saint Luc, Avenue Hippocrate, 10/2942; B-1200 Brussels, Belgium. , frederic.lecouvet@uclouvain.be
  organization: Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
BackLink https://www.ncbi.nlm.nih.gov/pubmed/27197649$$D View this record in MEDLINE/PubMed
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Issue 11
Keywords metastases
lymph nodes
MRI
prostate-cancer
radiotherapy
bone
oligometastasis
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Snippet OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic...
To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic resonance imaging...
OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease (≤3 synchronous lesions) using whole body magnetic...
OBJECTIVES To determine the proportion of prostate cancer (PCa) patients with oligometastatic disease ( less than or equal to 3 synchronous lesions) using...
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SubjectTerms Aged
bone
Bone Neoplasms - diagnostic imaging
Bone Neoplasms - secondary
Cancer therapies
Humans
Lymph Node Excision
lymph nodes
Lymph Nodes - pathology
Lymphatic Metastasis - diagnostic imaging
Magnetic Resonance Imaging
Male
metastases
Metastasis
Middle Aged
MRI
Neoplasm Metastasis - diagnostic imaging
NMR
Nuclear magnetic resonance
oligometastasis
Prostate cancer
Prostatectomy
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - therapy
Radiotherapy
Viscera - diagnostic imaging
Whole Body Imaging
Title Whole body MRI (WB-MRI) assessment of metastatic spread in prostate cancer: Therapeutic perspectives on targeted management of oligometastatic disease
URI https://api.istex.fr/ark:/67375/WNG-5M0F069J-D/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fpros.23196
https://www.ncbi.nlm.nih.gov/pubmed/27197649
https://www.proquest.com/docview/1797694873
https://www.proquest.com/docview/1798264171
https://www.proquest.com/docview/1808620351
Volume 76
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