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e15059 Background: Hyperpolarized 13 C (HP 13 C) MRI is a novel molecular imaging approach that detects aberrant aerobic metabolism, namely elevated rates of pyruvate-to-lactate conversion (k PL ), in patients with advanced malignancies. Higher k PL has been shown to correlate with higher tumor grade among patients with localized prostate cancer (PC). This research sought to evaluate the correlation between k PL and clinical outcome measures in patients with advanced PC. Methods: Patients with metastatic or locally advanced PC (castration sensitive or resistant) were prospectively enrolled at our institution and underwent HP 13 C MRI of one or more target lesions identified on prior conventional imaging. Voxelwise k PL values were computed in MATLAB using an inputless two site exchange model. k PL,median was defined as the median k PL value per-patient across all target lesions; k PL,kurtosis measured the tailedness of the k PL distribution per-patient. We retrospectively analyzed progression free survival (PFS) and overall survival (OS) in subgroups divided by metabolic activity below versus above cut-point (k PL,median 0.8). Conclusions: HP 13 C MRI-derived non-invasive metabolic biomarker k PL,median significantly correlated with clinical outcome measures in a retrospective analysis of patients with advanced PC, outperforming established serological prognostic markers PSA and LDH. Limitations include our small sample size, retrospective design, and heterogeneous patient population. Nevertheless, these encouraging preliminary results support further investigation of HP 13 C MRI as a prognostic and/or predictive PC biomarker in multi-center prospective imaging trials. Table: see text
Chen et al. (Sat,) studied this question.