Time‐dependent effects of hormone‐deprivation therapy on prostate metabolism as detected by combined magnetic resonance imaging and 3D magnetic resonance spectroscopic imaging

Combined MRI and 3D spectroscopic imaging (MRI/3D‐MRSI) was used to study the metabolic effects of hormone‐deprivation therapy in 65 prostate cancer patients, who underwent either short, intermediate, or long‐term therapy, compared to 30 untreated control patients. There was a significant time‐dependent loss of the prostatic metabolites choline, creatine, citrate, and polyamines during hormone‐deprivation therapy, resulting in the complete loss of all observable metabolites (total metabolic atrophy) in 25% of patients on long‐term therapy. The amount and time‐course of metabolite loss during therapy significantly differed for healthy and malignant tissues. Citrate levels decreased faster than choline and creatine levels during therapy, resulting in an increase in the mean (choline + creatine)/citrate ratio with duration of therapy. Due to a loss of all MRSI detectable citrate, this ratio could not be used to identify cancer in 69% of patients on long‐term therapy. In the absence of citrate, however, residual prostate cancer could still be detected by elevated choline levels (choline/creatine ratio ≥1.5), or the presence of only choline in the proton spectrum. The loss of citrate and the presence of total metabolic atrophy correlated roughly with decreasing serum prostatic specific antigen levels with increasing therapy. In summary, MRI/3D‐MRSI provided both a measure of residual cancer and a time‐course of metabolic response following hormone‐deprivation therapy. Magn Reson Med 46:49–57, 2001. © 2001 Wiley‐Liss, Inc.