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What is the appropriate margin for focal therapy of prostate cancer when using MRI/MRSI for treatment planning?

What is the appropriate margin for focal therapy of prostate cancer when using MRI/MRSI for treatment planning?. Proposed secondary study for ACRIN 6659 data. Fergus Coakley MD, Professor of Radiology and Urology, Chief, Abdominal Imaging, University of California San Francisco. Objective.

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What is the appropriate margin for focal therapy of prostate cancer when using MRI/MRSI for treatment planning?

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  1. What is the appropriate margin for focal therapy of prostate cancer when using MRI/MRSI for treatment planning? Proposed secondary study for ACRIN 6659 data Fergus Coakley MD, Professor of Radiology and Urology, Chief, Abdominal Imaging, University of California San Francisco

  2. Objective • Determine the appropriate margin for focal therapy of prostate cancer when planned from MRI/MRSI

  3. Background • Increasing interest in focal therapy as “middle way” for prostate cancer treatment • Active surveillance – minimalist • Definitive treatment (RRP or RT) – high morbidity • Three requirements for focal therapy: • Clinical selection – no consensus • Radiological selection – MRI criteria on next slide • Adequate margin – purpose of this proposal

  4. UCSF selection study • 88 patients with MRI/MRSI before RRP and with detailed tumor maps • MRI/MRSI reviewed by two independent readers • Dominant treatable foci = largest lesion & > 0.5cc • Results: • ALL visible lesions on T2 with ≥0.54 cm3 of concordant MRSI abnormality (n = 27 and 25 for reader 1 and 2, respectively) were correctly identified dominant treatable tumor foci

  5. Proposal (two steps) • Apply UCSF criteria to ACRIN database • T2 visible & ≥0.54 cm3 concordant MRSI • Two readers (remote or travel to ACRIN HQ?) • Anticipate small number will meet criteria (<10?) • Co-register digital pathology with T2 • Pick largest/best T2 image and “best match” pathology slide • Morph gland outline on pathology to T2 (allows margin measurement using MRI calipers) • Measure maximum margin (per quadrant and separate capsular from non-capsular?)

  6. Example “Best match” T2 MRI and pathology slice

  7. Example “Morph” pathology to T2

  8. Example “Morph” pathology to T2

  9. Example Measure margins – maximum capsular and non-capsular plus by quadrant?

  10. Analysis • Presumably will be essentially descriptive – what margin would have encompassed all the tumors? • Issues for discussion: • Explore additional selection criteria? • More than two reads? • Can readings be done remotely? • Who will fuse images and measure margins? • Funding level? Travel and/or time?

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