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Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment
Elisha Fredman1, Bryan Traughber1,2, Michael Kharouta1
1Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH, United States.
Frontiers in Oncology
|October 4, 2021
Summary
Focal SBRT for prostate cancer shows promise for truly focal disease, but careful patient selection is crucial due to frequent additional findings on biopsy. Focal radiation therapy (f-SBRT) demonstrated good outcomes with minimal toxicity in selected patients.
Area of Science:
- Urology
- Radiation Oncology
- Medical Imaging
Background:
- Multiparametric MRI (mpMRI) aids in identifying prostate adenocarcinoma foci.
- mpMRI enables potential for partial gland therapy.
- Focal SBRT (f-SBRT) is being investigated for localized prostate cancer treatment.
Purpose of the Study:
- To assess the feasibility of f-SBRT using diagnostic mpMRI and biopsy correlation.
- To evaluate the accuracy of imaging-pathology concordance in treatment planning for focal prostate cancer.
Main Methods:
- Prospective pilot trials involving patients with Gleason 6-7 disease and PIRADS 4-5 lesions.
- MRI/ultrasound fusion targeted and comprehensive biopsies were performed.
- Five of 18 patients proceeded to f-SBRT after rigorous concordance analysis.
Main Results:
- Absolute imaging-pathology concordance was 43.8%.
- Discordance patterns included additional ipsilateral, bilateral disease, or negative targets.
- Five patients completed f-SBRT with no grade 2+ toxicities and a 41% mean PSA decrease.
Conclusions:
- Rigorous imaging and pathology concordance revealed additional disease, necessitating caution in partial-gland therapy.
- f-SBRT is effective for truly focal disease, offering excellent dosimetry and biochemical response.
- Clinical trial registration numbers: NCT02681614; NCT02163317.
