Apparent Diffusion Coefficient as an Early Prognostic Factor of Response to Treatment with Androgen Deprivation Therapy and Radiotherapy in Patients with Prostate Cancer (Póster)

1. Duque-Santana, V. ¹²
2. Fernandez Mata, J. ¹
3. Diaz-Gavela, A. ¹
4. Recio, M. ¹
5. Peña Huertas, M. ¹
6. Sanchez, S. ³
7. Guerrero, L. ³
8. Sanz-Rosa, D. ²
9. Thuissard, I.J. ²
10. Andreu-Vázquez, C.
11. Lopez, F. ⁴
12. Diez Nicolas, V. ¹
13. del Cerro, E. ¹
14. Counago, F. ⁵

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DOI: 10.1016/J.IJROBP.2024.07.1168 GOOGLE SCHOLAR lock_openOpen access editor

More publications in: International Journal of Radiation Oncology*Biology*Physics

Abstract

Purpose/Objective(s): To analyzed the Apparent Diffusion Coefficient(ADC) as an early prognostic factor of response in patients with prostatecancer treated with radiotherapy (RT) and androgen deprivation therapy(ADT).Materials/Methods: All prostate cancer patients classified as high or veryhigh and unfavorable intermediate-risk according to NCCN criteria thatreceived ADT and RT between 2008 and 2019 in whom an multiparametricmagnetic resonance imaging (mpMRI) was performed were included. TheADC values were calculated by mpMRI performed 6 months after RT. Weassessed the differences in the mean ADC values between patients with orwithout progression and/or local relapse after 10 years. Receiver-operatingcharacteristics (ROC) analysis were used to obtain ADC cut-off values topredict 10y-progression-free survival and 10y-local progression survival inthese patients. Additionally, differences in ADC values between diagnosisand post-RT were assessed.Results: We retrospectively evaluated 98 consecutive patients, 25(25.5%)patients were intermediate-risk and 73 (74.5%) patients were high-risk.The median PSA at diagnosis was 10.15ng/ml [6.93-21]. After a mean follow-up of 95.36 months (SD:30.54), 19 (19.39%) patients progressed,10ybiochemical relapse-free survival was 76.5%, 10y-PFS was 75.6%, 10y-LRFSwas 93.8%, 10y metastasis-free survival was 85.5%, 10y overall survival was89.5%. The mean ADC values at diagnosis and post-RT was 0.81 § 0.18 vs1.30 § 0.18 x10-3 mm2/sec, respectively (p<0.001); and the mean relativeincrease in ADC values was 70.11% (SD:46.80). A statistically significantdifference in post-RT ADC values was noted between patients with andwithout recurrence (1.20 § 0.10 vs 1.30 § 0.20 x10-3 mm2/sec, p = 0.004).We also found significant differences in ADC values between patients with and without local relapse (1.10 § 0.10 vs 1.30 § 0.20 x10-3 mm2/sec, p =0.020). The ROC analysis identified post-RT ADC cut-off point of 1.24x10-3 mm2/sec for progression (area under curve (AUC) 0.705, sensitivity (S)72.2%, positive predictive value (PPV): 87.69%)) and a cut-off point of1.11x10-3 mm2/sec for local relapse (AUC: 0.843, S:89.4%, PPV: 98.82%).10-y LRFS was 66.8% and 97.7% in patients with post-RT ADC valuesbelow and above 1.11x10-3 mm2/sec, respectively (HR:724.8 [31.28-16.793];p<0.001). 10-y PFS was 58.6% and 85.6% in patients with post-RT ADCvalues below and above 1.24 10-3 mm2/sec (HR: 2.916 [1.113-7.644] p =0.015). Patients whose ADC values increased >95% between diagnosis andpost-RT had a lower risk of relapses (4.76% vs.26.56%, p < 0.001).Conclusion: This is the first study with a long follow-up that shows thatpost-RT ADC value could be used as a prognostic factor of response inpatients with prostate cancer treated with radiotherapy and ADT.