Prognostic value of MRI-derived features for biochemical recurrence after curative radiotherapy in prostate cancer

Alexander Herold ^1,2, Maximilian Pohl ^1,3, Stephan M Korn ^4,5

¹Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
²Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
³Department of Radiology, Medical University of Graz, Graz, Austria.
⁴Department of Urology, Medical University of Vienna, Vienna, Austria.
⁵Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
⁶Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
⁷Massachusetts General Hospital Cancer Center, Boston, USA.
⁸Department of Radiology, Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, USA.
⁹Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. onofriocatalano@yahoo.it.
¹⁰Department of Radiology, Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, USA. onofriocatalano@yahoo.it.

⁰Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Abdominal Radiology (new York) +

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September 20, 2025

View abstract on PubMed

Summary

Pretreatment multiparametric MRI features, particularly neurovascular bundle invasion (NBI), can predict biochemical recurrence in localized prostate cancer patients treated with radiation therapy. This imaging insight aids in refining risk stratification for better patient outcomes.

Area Of Science

Oncology
Radiology
Urology

Background

Localized prostate cancer is often treated with curative intent radiation therapy.
Predicting biochemical recurrence after radiation therapy is crucial for patient management.
Multiparametric MRI (mpMRI) offers detailed imaging of prostate cancer characteristics.

Purpose Of The Study

To determine if pretreatment multiparametric MRI features can predict biochemical recurrence in patients with localized prostate cancer.
To identify specific MRI parameters associated with recurrence risk following radiation therapy.

Main Methods

Retrospective analysis of 54 prostate cancer patients treated with primary radiotherapy (2015-2019).
Assessment of clinical, pathological, and pretreatment mpMRI features (qualitative and quantitative).
Logistic regression analysis to identify predictors of biochemical recurrence (Phoenix criteria).

Main Results

Biochemical recurrence occurred in 18.5% of patients at a median follow-up of 74.4 months.
Univariate analysis showed clinical T-stage, ISUP grade, NCCN risk groups, tumor volume, EPE, NBI, and seminal vesicle invasion as significant predictors.
Stepwise multivariate analysis identified neurovascular bundle invasion (NBI) as the sole independent predictor of recurrence (OR: 3.16, p=0.001), with high specificity (86.4%) and NPV (92.7%).

Conclusions

Pretreatment neurovascular bundle invasion (NBI) on multiparametric MRI is an independent predictor of biochemical recurrence in localized prostate cancer treated with radiation therapy.
Incorporating imaging criteria, specifically NBI, into risk stratification models can improve prediction accuracy.
This highlights the value of advanced MRI techniques in guiding treatment decisions and follow-up strategies for prostate cancer patients.

Keywords:

Biochemical recurrence Magnetic resonance imaging Prostate cancer Radiation therapy Risk stratification