Definitive 3D-CRT for clinically localized prostate cancer: modifications of the clinical target volume following a prostate MRI and the clinical benefits

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Table 3 Upstaging and changes in the CTV among the risk groups after prostate MRI according to the Prostate Cancer Risk Stratification (ProCaRS) risk stratification system

ProCaRS 6 categories^a before prostate MRI	Upstaging of the T stage after prostate MRI (n = 33) (%)	Upstaging of the NCCN risk group after prostate MRI (n = 10) (%)	Modifications of the CTV in 3D-CRT planning based on the prostate MRI findings (n = 11) (%)
Very low-risk	1 (3)	1 (10)	1 (9)
Low-risk	3 (9)	1 (10)	1 (9)
Low intermediate-risk	8 (24)	1 (10)	1 (9)
High intermediate-risk	7 (21)	2 (20)	2 (18)
High-risk	4 (12)	3 (30)	4 (36)
Extreme-risk	10 (30)	2 (20)	2 (18)

Very low-risk: T1–T2a AND PSA ≦6 ng/ml AND Gleason score ≦6. Low-risk: T1–T2a AND PSA >6 AND PSA ≦10 ng/ml AND Gleason score ≦6. Low intermediate-risk: T1–T2 AND PSA ≦20 mg/ml AND [PSA ≦10 ng/ml OR (PSA > 10 ng/ml AND {T1–T2a OR Gleason ≦6})]. High intermediate-risk: T1–T2 AND PSA ≦20 mg/ml AND [PSA >10 ng/ml AND (T2b/c OR Gleason 7)]. High-risk: [T3–T4 OR (PSA >20 ng/ml AND PSA <30 ng/ml) OR Gleason 8–10] AND % cores <87.5%. Extreme-risk: [(T3–T4 OR Gleason 8–10 OR PSA >20 ng/ml)] AND (PSA ≧30 ng/ml OR % cores ≧87.5%).
^aRodrigues et al. (2013).