Guidance of treatment decisions in risk-adapted primary radiotherapy for XXXX using multiparametric magnetic resonance imaging: a single center experience.

@entity5 @entity1 @entity263 @entity342
BACKGROUND: Magnetic resonance imaging (MRI) of the prostate is considered to be the most precise noninvasive staging modality for @entity263 . Multiparametric MRI (mpMRI) dynamic sequences have recently been shown to further increase the accuracy of staging relative to morphological imaging alone. Correct radiological staging, particularly the detection of extraprostatic disease extension, is of paramount importance for target volume definition and dose prescription in highly-conformal curative radiotherapy (RT); in addition, it may affect the risk-adapted duration of additional antihormonal therapy. The purpose of our study was to analyze the impact of mpMRI-based @entity5 staging in @entity1 undergoing primary @entity263 . METHODS: A total of 122 @entity1 admitted for primary @entity263 were retrospectively analyzed regarding initial clinical and computed tomography-based staging in comparison with mpMRI staging. Both @entity5 stage shifts and overall risk group shifts, including prostate-specific antigen (PSA) level and the Gleason score, were assessed. Potential risk factors for upstaging were tested in a multivariate analysis. Finally, the impact of mpMRI-based staging shift on prostate RT and antihormonal therapy was evaluated. RESULTS: Overall, @entity5 stage shift occurred in 55.7% of @entity1 after mpMRI. Upstaging was most prominent in @entity1 showing high-risk serum PSA levels (73%), but was also substantial in @entity1 presenting with low-risk PSA levels (50%) and low-risk Gleason scores (45.2%). Risk group changes occurred in 28.7% of the @entity1 with consequent treatment adaptations regarding target volume delineation and duration of @entity342 deprivation therapy. High PSA levels were found to be a significant risk factor for @entity5 upstaging and newly diagnosed seminal vesicle infiltration assessed using mpMRI. CONCLUSIONS: Our findings suggest that mpMRI of the prostate leads to substantial @entity5 upstaging, and can considerably affect treatment decisions in all @entity1 groups undergoing risk-adapted curative @entity263 .
