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Magnetic resonance spectroscopy in patients with locally confined prostate cancer: association of prostatic citrate and metabolic atrophy with time on hormone deprivation therapy, PSA level, and biopsy Gleason score

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Abstract

This study was undertaken to determine respective associations between prostatic citrate or metabolic atrophy (no detectable citrate, choline, and creatine) at magnetic resonance spectroscopy (MRS) and time on hormone-deprivation therapy, serum PSA, and biopsy Gleason score. Clinical data, histopathology reports and PSA levels of 36 patients on hormone-deprivation therapy (age, 64±9 years, pre-therapeutic biopsy Gleason sum, median 6, range 3–8, antiandrogens only, n=3, LHRH-analogues only, n=4, combined hormone-deprivation therapy, n=29, duration, 27±19 weeks) for locally confined prostate cancer (PCA) were retrospectively correlated with findings in the peripheral zone of the prostate at 3D-MRS (endorectal coil, PRESS, TR 1,000 ms, TE 130 ms). The results show that citrate was usually detected after 13 weeks or less of hormone-deprivation therapy (10/12 vs. 6/24 patients, chi-square-test, p=0.002). All patients with PSA levels exceeding 0.20 ng/ml had detectable metabolites (citrate, n=12, choline without citrate, n=6), while 9/18 patients with PSA 0.20 ng/ml or less showed metabolic atrophy (Fisher-exact-test, p=0.001). There were no significant associations between citrate, metabolic atrophy, pre-therapeutic PSA, and biopsy Gleason sum, respectively. It has been concluded that hormone-deprivation therapy for locally confined PCA has not reached its full deprivation potential after 13 weeks. MRS detects prostate metabolism in patients with PSA exceeding 0.20 ng/ml after hormone-deprivation therapy.

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References

  1. Costello LC, Franklin RB (1991) Concepts of citrate production and secretion by prostate. 1. Metabolic relationships. Prostate 1991:25–46

    Article  Google Scholar 

  2. Kurhanewicz J, Vigneron DB, Nelson SJ, Hricak H, MacDonald JM, Konety B, Narayan P (1995) Citrate as an in vivo marker to discriminate prostate cancer from benign prostatic hyperplasia and normal prostate peripheral zone: detection via localized proton spectroscopy. Urology 45:459–466

    Article  PubMed  CAS  Google Scholar 

  3. Kurhanewicz J, Vigneron DB, Hricak H, Narayan P, Carroll P, Nelson SJ (1996) Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24-0.7-cm3) spatial resolution. Radiology 198:795–805

    PubMed  CAS  Google Scholar 

  4. Costello LC, Franklin RB, Narayan P (1999) Citrate in the diagnosis of prostate cancer. Prostate 38:237–245

    Article  PubMed  CAS  Google Scholar 

  5. Kurhanewicz J, Swanson MG, Nelson SJ, Vigneron DB (2002) Combined magnetic resonance imaging and spectroscopic imaging approach to molecular imaging of prostate cancer. J Magn Reson Imaging 16:451–463

    Article  PubMed  Google Scholar 

  6. Mueller-Lisse UG, Scherr M (2003) 1H-MR-Spektroskopie der Prostata: ein Überblick. Radiologe 43:481–488

    Article  PubMed  CAS  Google Scholar 

  7. Gleave ME, Goldenberg SL, Jones EC, Bruchovsky N,Sullivan LD (1996) Biochemical and pathological effects of 8 months of neoadjuvant androgen withdrawal therapy before radical prostatectomy in patients with clinically confined prostate cancer. J Urol 155:213–219

    Article  PubMed  CAS  Google Scholar 

  8. Costello LC, Franklin RB (1991) Concepts of citrate production and secretion by prostate. 2. Hormonal relationships in normal and neoplastic prostate. Prostate 19:181–205

    Article  PubMed  CAS  Google Scholar 

  9. Mueller-Lisse UG, Swanson MG, Vigneron DB, Hricak H, Bessette A, Males RG, Wood PJ, Noworolski S, Nelson SJ, Barken I, Carroll PR, Kurhanewicz J (2001) Time-dependent effects of hormone-deprivation therapy on prostate metabolism as detected by combined magnetic resonance imaging and 3D magnetic resonance spectroscopic imaging. Magn Reson Med 46:49–57

    Article  PubMed  CAS  Google Scholar 

  10. Mueller-Lisse UG, Vigneron DB, Hricak H, Swanson MG, Carroll PR, Bessette A, Scheidler J, Srivastava A, Males RG, Cha I, Kurhanewicz J (2001) Localized prostate cancer: effect of hormone deprivation therapy measured by using combined three-dimensional 1H MR spectroscopy and MR imaging: clinicopathologic case-controlled study. Radiology 221:380–390

    Article  PubMed  CAS  Google Scholar 

  11. Civantos F, Marcial MA, Banks ER, Ho CK, Speights VO, Drew PA, Murphy WM, Soloway MS (1995) Pathology of androgen deprivation therapy in prostate carcinoma: a comparative study of 173 patients. Cancer 75:1634–1641

    Article  PubMed  CAS  Google Scholar 

  12. Cookson MS, Sogani PC, Russo P, Sheinfeld J, Herr H, Dalbagni G, Reuter VE, Begg CB, Fair WR (1997) Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study. Br J Urol 79:432–438

    PubMed  CAS  Google Scholar 

  13. Labrie F, Dupont A, Cusan L, Gomez J, Diamond P, Koutsilieris M, Suburu R, Fradet Y, Lemay M, Tetu B, et al (1993) Downstaging of localized prostate cancer by neoadjuvant therapy with flutamide and lupron: the first controlled and randomized trial. Clin Invest Med 16:499–509

    PubMed  CAS  Google Scholar 

  14. Solomon MH, McHugh TA, Dorr RP, Lee F, Siders DB (1993) Hormone ablation therapy as neoadjuvant treatment to radical prostatectomy. Clin Invest Med 16:532–538

    PubMed  CAS  Google Scholar 

  15. Vailancourt L, Ttu B, Fradet Y et al (1996) Effect of neoadjuvant endocrine therapy (combined androgen blockade) on normal prostate and prostatic carcinoma: a randomized study. Am J Surg Pathol 20:86–93

    Article  PubMed  CAS  Google Scholar 

  16. van Poppel H, de Ridder D, Elgamal AA, van de Voorde W, Werbrouck P, Ackaert K, Oyen R, Pittomvils G, Baert L (1995) Neoadjuvant hormonal therapy before radical prostatectomy decreases the number of positive surgical margins in stage T2 prostate cancer: interim results of a prospective randomized trial: The Belgian Uro-Oncological Study Group. J Urol 154:429–434

    Article  PubMed  Google Scholar 

  17. Wieder JA, Soloway MS (1998) Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol 160:299–315

    Article  PubMed  CAS  Google Scholar 

  18. Witjes WP, Schulman CC, Debruyne FM (1997) Preliminary results of a prospective randomized study comparing radical prostatectomy versus radical prostatectomy associated with neoadjuvant hormonal combination therapy in T2-3 N0 M0 prostatic carcinoma: The European Study Group on Neoadjuvant Treatment of Prostate Cancer. Urology 49:65–69

    Article  PubMed  CAS  Google Scholar 

  19. Zelefsky MJ, Harrison A (1997) Neoadjuvant androgen ablation prior to radiotherapy for prostate cancer: reducing the potential morbidity of therapy. Urology 49(3A Suppl):38–45

    Article  PubMed  CAS  Google Scholar 

  20. Gleave ME, La Bianca SE, Goldenberg SL, Jones EC, Bruchovsky N, Sullivan LD (2000) Long-term neoadjuvant hormone therapy prior to radical prostatectomy: evaluation of risk for biochemical recurrence at 5-year follow-up. Urology 56:289–294

    Article  PubMed  CAS  Google Scholar 

  21. Klotz L, Gleave M, Goldenberg SL (2000) Neoadjuvant hormone therapy: the Canadian trials. Mol Urol 4:233–239

    PubMed  CAS  Google Scholar 

  22. Grossfeld GD, Chaudhary UB, Reese DM, Carroll PR, Small EJ (2001) Intermittent androgen deprivation: update of cycling characteristics in patients without clinically apparent metastatic prostate cancer. Urology 58:240–245

    Article  PubMed  CAS  Google Scholar 

  23. Mueller-Lisse UG, Heuck AF, Schneede P, Muschter R, Scheidler J, Hofstetter AG, Reiser MF (1996) Postoperative MRI in patients undergoing interstitial laser coagulation thermotherapy of benign prostatic hyperplasia. J Comput Assist Tomogr 20:273–278

    Article  PubMed  CAS  Google Scholar 

  24. Star LJ, Nelson SJ, Kurhanewicz J, Huang LR, Vigneron DB (1997) Improved water and lipid suppression for 3D PRESS CSI using RF band selective inversion with gradient dephasing (BASING). Magn Reson Med 38:311–321

    Article  Google Scholar 

  25. Bottomley PA (1987) Spatial localization in NMR spectroscopy in vivo. Ann N Y Acad Sci 508:333–348

    Article  PubMed  CAS  Google Scholar 

  26. Heerschap A, Jager GJ, van, der, Graaf, M, Barentsz JO, Ruijs SH (1997) Proton MR spectroscopy of the normal human prostate with an endorectal coil and a double spin-echo pulse sequence. Magn Reson Med 37:204–213

    Article  PubMed  CAS  Google Scholar 

  27. Schick F, Bongers H, Kurz S, Jung WI, Pfeffer M, Lutz O (1993) Localized proton MR spectroscopy of citrate in vitro and of the prostate in vivo at 1.5 T. Magn Reson Med 29:38–43

    Article  PubMed  CAS  Google Scholar 

  28. Moyher SE, Vigneron DB, Nelson SJ (1995) Surface coil MR imaging of the human brain with an analytic reception profile correction. J Magn Reson Imaging 5:139–144

    Article  PubMed  CAS  Google Scholar 

  29. Nelson SJ, Brown TR (1987) A new method for automatic quantification of 1-D spectra with low signal to noise ratio. J Magn Reson 75:229–243

    Google Scholar 

  30. Glantz SA (1997) Primer of biostatistics, 4th edn. McGraw-Hill, New York

  31. Fair WR, Cookson MS, Stroumbakis N et al (1997) The indications, rationale, and results of neoadjuvant androgen deprivation in the treatment of prostatic cancer: Memorial Sloan-Kettering Cancer Center results. Urology 49:46–55

    Article  PubMed  CAS  Google Scholar 

  32. Lee F, Siders DB, McHugh TA, Solomon MH, Klamerus ML (1997) Long-term follow-up of stages T2-T3 prostate cancer pretreated with androgen ablation therapy prior to radical prostatectomy. Anticancer Res 17:1507–1510

    PubMed  CAS  Google Scholar 

  33. Leibowitz RL, Tucker SJ (2001) Treatment of localized prostate cancer with intermittent triple androgen blockade: preliminary results in 110 consecutive patients. Oncologist 6:177–182

    Article  PubMed  CAS  Google Scholar 

  34. Peyromaure M, Delongchamps NB, Debre B, Zerbib M (2005) Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: long-term experience. Urology 65:724–729

    Article  PubMed  Google Scholar 

  35. Gulley JL, Figg WD, Steinberg SM, Carter J, Hussain MH, Dahut WL (2005) A prospective analysis of the time to normalization of serum androgens following 6 months of androgen deprivation therapy in patients on a randomized phase III clinical trial using limited hormonal therapy. J Urol 173:1567–1571

    Article  PubMed  CAS  Google Scholar 

  36. Lichy MP, Pintaske J, Kottke R, Machann J, Anastasiadis A, Roell S, Hennenlotter J, Diergarten T, Schick F, Stenzl A, Claussen CD, Schlemmer HP (2005) 3D proton MR spectroscopic imaging of prostate cancer using a standard spine coil at 1.5 T in clinical routine: a feasibility study. Eur Radiol 15:653–660

    Article  PubMed  Google Scholar 

  37. Rouviere O, Hartman RP, Lyonnet D (2006) Prostate MR imaging at high-field strength: evolution or revolution? Eur Radiol 16:276–284

    Article  PubMed  Google Scholar 

  38. Wetter A, Hubner F, Lehnert T, Fliessbach K, Vorbuchner M, Roell S, Zangos S, Luboldt W, Vogl TJ (2005) Three-dimensional 1H-magnetic resonance spectroscopy of the prostate in clinical practice: technique and results in patients with elevated prostate-specific antigen and negative or no previous prostate biopsies. Eur Radiol 15:645–652

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was supported in part by grants NIH R01-59897 and NIH R29-64667 and the Association for the Cure of Cancer of the Prostate Foundation.

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Authors and Affiliations

  1. Department of Radiology, University of California, San Francisco, CA, 94143, USA

    Mark G. Swanson, Daniel B. Vigneron & John Kurhanewicz

  2. Institut fur Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universitaet, Muenchen-Innenstadt, Ziemssenstrasse 1, 80336, Muenchen, Germany

    Ullrich G. Mueller-Lisse

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  1. Ullrich G. Mueller-Lisse
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  2. Mark G. Swanson
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  3. Daniel B. Vigneron
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  4. John Kurhanewicz
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Correspondence to Ullrich G. Mueller-Lisse.

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Mueller-Lisse, U.G., Swanson, M.G., Vigneron, D.B. et al. Magnetic resonance spectroscopy in patients with locally confined prostate cancer: association of prostatic citrate and metabolic atrophy with time on hormone deprivation therapy, PSA level, and biopsy Gleason score. Eur Radiol 17, 371–378 (2007). https://doi.org/10.1007/s00330-006-0321-3

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