Multiparametric MRI for prostate cancer: a national survey of patterns of practice among radiation oncologists in Spain
To investigate patterns of practice among Spanish radiation oncologists in the use of multiparametric magnetic resonance imaging (mpMRI) for the treatment of prostate cancer (PCa). We evaluated (1) access to mpMRI, (2) current clinical practices, and (3) physician expectations of mpMRI.
Cross-sectional survey of 118 radiation oncologists at 75 Radiation Oncology (RO) departments in Spain.
A total of 55 radiation oncologists from 52 RO departments (52/75; 69%) completed the survey. Prostate mpMRI is performed at 94.5% of the centres that provided data. The most common indications for mpMRI in routine clinical practice were: (1) detection/localization of the tumour prior to second biopsy (82.7%), (2) cancer staging (80.8%), and (3) detection of recurrence after definitive treatment (80.8%). Most respondents (72.7%) reported modifying the primary radiotherapy treatment when mpMRI findings indicate a more advanced T stage with a resultant change in the risk group. Most respondents (90.5%) treat macroscopic local recurrence after prostatectomy with high doses, ranging from 71 to 83 Gy; in 37.7% of cases, the full dose is delivered to the entire prostate bed. In pelvic nodal recurrence, more than half (59.3%) of the respondents reported performing elective pelvic radiotherapy, including the prostate bed, with a boost to the involved nodes.
This survey shows that prostate mpMRI is routinely used by radiation oncologists in Spain in a wide range of clinical scenarios. The findings reported here underscore the need to standardize treatment protocols for definitive and salvage radiotherapy in patients evaluated with mpMRI.
KeywordsProstate cancer Magnetic resonance imaging Radiation oncologists Survey
We thank all the participants in the study for helping to contribute to a greater understanding of the situation of mpMRI in Spain (the participating hospitals are listed in Online Resource 1). The authors would like to thank to Israel John Thuissard and David Sanz-Rosa for their support with the statistical analysis and creation of the figures in this manuscript. We thank Bradley Londres for his excellent work in translating and editing this manuscript.
The translation of this work was supported financially by the Spanish Society of Radiation Oncology.
Compliance with ethical standards
Conflict of interest
All authors declared no conflicts of interest.
Research involving human participants and/or animals
- 1.Epidemiology of prostate cancer in Europe [Internet]. EU SCIENCE HUB. [cited 2017]. https://ec.europa.eu/jrc/en/publication/epidemiology-prostate-cancer-europe.
- 13.ESUR Guidelines. Prostate MRI. Prostate Imaging and Report and Data System (PIRADS):Version 2. http://www.esur.org/fileadmin/content/user_upload/PIRADS_v2_20141223.pdf.
- 14.Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2015;68(3):438–50.CrossRefPubMedGoogle Scholar
- 15.Mottet N, van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, et al. European Association of Urology. Prostate Cancer Guidelines. 2018. http://uroweb.org/guideline/prostate-cancer/#1.
- 16.Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018. (Epub ahead of print).Google Scholar
- 17.Buyyounouski MK, Choyke PL, Kattan MW, McKenney JK, Srigley JR, Barocas DA, et al. American Join Committee on cancer staging manual. 8th ed. Chicago: Springer; 2017.Google Scholar
- 18.Gomez-Iturriaga A, Casquero F, Pijoan JI, Crook J, Urresola A, Ezquerro A, et al. Pretreatment multiparametric magnetic resonance imaging findings are more accurate independent predictors of outcome than clinical variables in localized. prostate cancer. Int J Radiat Oncol Biol Phys. 2018. https://doi.org/10.1016/j.ijrobp.2018.04.039 (In press).CrossRefGoogle Scholar
- 23.Carrie C, Hasbini A, de Laroche G, Richaud P, Guerif S, Latorzeff I, et al. Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016;17(6):747–56.CrossRefPubMedGoogle Scholar