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- Title
MRI findings in men on active surveillance for prostate cancer: does dutasteride make MRI visible lesions less conspicuous? Results from a placebo-controlled, randomised clinical trial.
- Authors
Giganti, Francesco; Moore, Caroline; Robertson, Nicola; McCartan, Neil; Jameson, Charles; Bott, Simon; Winkler, Mathias; Gambarota, Giulio; Whitcher, Brandon; Castro, Ramiro; Emberton, Mark; Allen, Clare; Kirkham, Alex; Moore, Caroline M; Robertson, Nicola L; Bott, Simon R J
- Abstract
<bold>Objectives: </bold>To investigate changes in the Apparent Diffusion Coefficient (ADC) using diffusion-weighted imaging (DWI) in men on active surveillance for prostate cancer taking dutasteride 0.5 mg or placebo.<bold>Methods: </bold>We analysed 37 men, randomised to 6 months of daily dutasteride (n = 18) or placebo (n = 19), undergoing 3T multi-parametric Magnetic Resonance Imaging (mpMRI) scans at baseline and 6 months. Images were reviewed blind to treatment allocation and clinical information. Mean ADC of peripheral (PZ) and transition (TZ) zones, and MR-suspicious lesions were compared between groups over 6 months. Conspicuity was defined as the PZ divided by tumour ADC, and its change over 6 months was assessed.<bold>Results: </bold>A decrease in mean conspicuity in the dutasteride group (but not the controls) was seen over 6 months (1.54 vs 1.38; p = 0.025). Absolute changes in ADC and conspicuity were significantly different between placebo and dutasteride groups at 6 months: (-0.03 vs 0.08, p = 0.033) and (0.11 vs -0.16, p = 0.012), as were percentage changes in the same parameters: (-2.27% vs 8.56% p = 0.048) and (9.25% vs -9.89% p = 0.013).<bold>Conclusions: </bold>Dutasteride was associated with increased tumour ADC and reduced conspicuity. A lower threshold for triggering biopsy might be considered in men on dutasteride undergoing mpMRI for prostate cancer.<bold>Key Points: </bold>• Dutasteride increases ADC and reduces conspicuity in small mpMRI-visible prostate cancers. • Knowledge of dutasteride exposure is important in the interpretation of prostate mpMRI. • A lower threshold for triggering biopsy may be appropriate on dutasteride.
- Subjects
DIAGNOSIS; PROSTATE cancer; DIFFUSION magnetic resonance imaging; DIFFUSION coefficients; PLACEBOS; BIOPSY; ENZYME inhibitors; COMPARATIVE studies; MAGNETIC resonance imaging; RESEARCH methodology; MEDICAL cooperation; PROSTATE tumors; RESEARCH; BENIGN prostatic hyperplasia; EVALUATION research; RANDOMIZED controlled trials
- Publication
European Radiology, 2017, Vol 27, Issue 11, p4767
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-017-4858-0