Avery Allan, Sussman Marshall, Longo Joseph, Menezes Ravi J, Hamilton Robert J, der Kwast Theodorus H van, Fleshner Neil E, Penn Linda Z, Ghai Sangeet
Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Can Assoc Radiol J. 2021 Nov;72(4):750-758. doi: 10.1177/0846537120988262. Epub 2021 Feb 10.
To assess the role of multi-parametric MRI (mpMRI) in assessment of tumor response to fluvastatin administered prior to radical prostatectomy.
Men with MRI-visible, clinically significant prostate cancer and due to be treated with radical prostatectomy were prospectively enrolled. mpMRI was performed at baseline and following 6-7 week of neoadjuvant oral statin therapy (40 mg fluvastatin, twice daily), prior to prostatectomy. MRI assessment included tumor size, T2 relaxation time, ADC value, K-trans (volume transfer constant), Kep (reflux constant), and Ve (fractional volume) parameters at the 2 time points. Initial prostate needle biopsy cores, prior to starting oral statin therapy, corresponding to site of tumor on radical prostatectomy specimens were selected for analysis. The effect of fluvastatin on tumor proliferation (marker Ki67) and on tumor cell apoptosis (marker cleaved Caspase-3, CC3) were analyzed and correlated with MRI findings.
Nine men with paired MRI studies were included in the study. Binary histopathological data was available for 6 of the participants. No significant change in tumor size ( = 0.898), T2 relaxation time ( = 0.213), ADC value ( = 0.455), K-trans ( = 0.613), Kep ( = 0.547) or Ve ( = 0.883) between the time of biopsy and prostatectomy were observed. No significant change in tumor proliferation (%Ki67-positive cells, = 0.766) was observed by immunohistochemistry analysis. However, there was a significant increase in tumor cell apoptosis (%CC3-positive cells, = 0.047).
mpMRI techniques may not be sufficiently sensitive to detect the types (or magnitude) of tumor cell changes observed following 6-7 weeks of fluvastatin therapy for prostate cancer.
评估多参数磁共振成像（mpMRI）在评估前列腺癌根治术前服用氟伐他汀后肿瘤反应中的作用。
前瞻性纳入患有MRI可见的、具有临床意义的前列腺癌且计划接受前列腺癌根治术的男性患者。在基线时以及新辅助口服他汀类药物治疗（40mg氟伐他汀，每日两次）6 - 7周后、前列腺癌根治术前进行mpMRI检查。MRI评估包括两个时间点的肿瘤大小、T2弛豫时间、表观扩散系数（ADC）值、容积转移常数（K-trans）、回流常数（Kep）和分数容积（Ve）参数。选择开始口服他汀类药物治疗前、与前列腺癌根治术标本上肿瘤部位相对应的初始前列腺穿刺活检组织芯进行分析。分析氟伐他汀对肿瘤增殖（标志物Ki67）和肿瘤细胞凋亡（标志物裂解型半胱天冬酶 - 3，CC3）的影响，并与MRI结果进行关联。
9名接受了配对MRI研究的男性纳入本研究。6名参与者有二元组织病理学数据。在活检时和前列腺癌根治术之间，未观察到肿瘤大小（P = 0.898）、T2弛豫时间（P = 0.213）、ADC值（P = 0.455）、K-trans（P = 0.613）、Kep（P = 0.547）或Ve（P = 0.883）有显著变化。免疫组织化学分析未观察到肿瘤增殖（Ki67阳性细胞百分比，P = 0.766）有显著变化。然而，肿瘤细胞凋亡（CC3阳性细胞百分比，P = 0.047）有显著增加。
mpMRI技术可能不够敏感，无法检测到前列腺癌患者接受氟伐他汀治疗6 - 7周后观察到的肿瘤细胞变化类型（或程度）。
