Early changes in apparent diffusion coefficient from diffusion-weighted MR imaging during radiotherapy for prostate cancer

Purpose: To investigate the feasibility of diffusion-weighted MRI (DWI) as an early and reproducible change indicator in patients receiving radiotherapy for prostate cancer (PC). Methods and Materials: Eight consecutive patients with biopsy-proven PC underwent DWI at 3T. All patients who received external-beam radiotherapy had four serial MR scans, as follows: before therapy (PreTx); after 1 week of therapy (PostT1); after 3 weeks of therapy (PostT2); and 1 month after the completion of therapy (PostT3). At each time, the apparent diffusion coefficient (ADC) was measured in tumors and normal tissues. For reproducibility of the ADC measurement, five patients also had two separate pretreatment DWI scans at an interval of <2 weeks. Serum prostate-specific antigen (PSA) levels were evaluated at the same time as MR scans. Results: Thirteen tumors (peripheral zone = 10; transition zone = 3) were found. The mean ADC values for the tumors from PreTx to PostT3 were 0.86, 1.03, 1.15, and 1.26 × 10 ^-3 mm ²/s in sequence, respectively. Compared with PreTx, PostT1 (p = 0.005), PostT2 (p = 0.003), and PostT3 (p < 0.001) showed a significant increase in ADC values. The mean ADC values of the benign tissues from PreTx to PostT3 were 1.60, 1.58, 1.47, and 1.46 × 10 ^-3 mm ²/s in sequence, respectively. Reproducibility of ADC measurements was confirmed with a mean difference in ADC of -0.04 in peripheral zone and -0.017 in transition zone between two separate pretreatment MR scans. The mean PSA levels from PreTx to PostT3 were 9.05, 9.18, 9.25, and 4.11 ng/mL in sequence, respectively. Conclusions: DWI, as a reproducible biomarker, has the potential to evaluate the early therapeutic changes of PC to radiotherapy.