Analysis of the correlation between endorectal MRI response to neoadjuvant chemotherapy and biochemical recurrence in patients with high-risk localized prostate cancer

We have explored the prognostic significance of post-treatment changes in endorectal magnetic resonance imaging measurements and PSA, to generate further support for the use of these parameters as intermediate end points in future neoadjuvant trials

M D Galsky

2013

Scholarcy highlights

  • Prostate cancer is the most common cancer diagnosed in men in the United States. In the ‘PSA-era’, the vast majority of patients with prostate cancer present with clinically localized disease and are cured with surgery or radiation, or may even be safely monitored without immediate intervention on surveillance protocols. a subset of men with clinically localized prostate cancer harbor micrometastases, and relapse despite local therapy, contributing to over 30 000 prostate cancer deaths per year in the United States alone. Clinico-pathologic features have been identified that may be utilized to identify this high-risk group of men. several groups have explored the integration of neoadjuvant chemotherapy, before radical prostatectomy, in an attempt to improve the outcomes of these patients
  • On Trial 2, serum PSA measurements were obtained at baseline and on day 1 of each neoadjuvant chemotherapy cycle. This primary objective of this analysis was to evaluate the association between endorectal magnetic resonance imaging response and clinical outcome, in patients with high-risk localized prostate cancer treated with docetaxelbased neoadjuvant therapy
  • We explored two potential intermediate end points utilized in trials of neoadjuvant docetaxel
  • ErMRI response did not correlate with prolonged time to biochemical recurrence and, may be associated with worse outcomes
  • The current analysis reveals that 1.5T erMRI response on T2 weighted images does not correlate with a longer time until biochemical recurrence in patients with high-risk localized prostate cancer treated with neoadjuant docetaxel-based therapy, and may be associated with inferior clinical outcomes
  • PSA response did not correlate with biochemical recurrence and paradoxically erMRI response was associated with a significantly shorter time to biochemical recurrence
  • These findings do not support the use of erMRI response, utilizing the techniques employed in these studies, as a primary end point in future trials of neoadjuvant chemotherapy in prostate cancer
  • More active recently developed neoadjuvant hormonal therapy regimens may allow the exploration of major pathologic responses as intermediate end points in this clinical disease state, expediting the integration of multimodality approaches for high-risk localized disease

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