{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:28:28Z","timestamp":1784248108417,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: To analyze the predictive value of the apparent diffusion coefficient (ADC) in patients with prostate cancer (PCa) treated with radiotherapy (RT) and androgen deprivation therapy (ADT). Methods: Retrospective study of patients with high-risk, very high-risk, or unfavorable intermediate-risk PCa who received RT and ADT between 2008 and 2019 and underwent multiparametric magnetic resonance imaging mpMRI) at 6 months post-RT. Differences in ADC values were compared between patients with and without progression and\/or local recurrence. Receiver operating characteristic (ROC) curves were used to obtain ADC cutoffs for predicting 10-year progression-free-survival (PFS) and local recurrence-free survival (LRFS). Results: We evaluated 98 patients (73 [74.5%] high-risk). Over a mean \u00b1 SD follow-up of 95.36 \u00b1 30.54 months, 19 patients (19.4%) progressed; at 10 years, PFS was 75.6%, LRFS 93.8%, metastasis-free survival 85.5%, and overall survival 89.5%. Post-RT ADC was significantly lower in patients with local recurrence (1.09 \u00b1 0.18 vs. 1.30 \u00b1 0.20 \u00d7 10\u22123 mm2\/s, p = 0.020) and progression (1.23 \u00b1 0.20 vs. 1.30 \u00b1 0.21 \u00d7 10\u22123 mm2\/s, p = 0.004). ROC analysis identified a post-RT ADC cutoff of 1.11 \u00d7 10\u22123 mm2\/s for local recurrence (area under curve [AUC] 0.843, sensitivity 89.4%, positive predictive value [PPV] 98.8%). The cutoff for progression was 1.24 \u00d7 10\u22123 mm2\/s (AUC0.705, sensitivity 72.2%, PPV87.7%). Patients with a post-RT ADC value below and above 1.11 \u00d7 10\u22123 mm2\/shad a 10-year LRFS of 66.8% and 97.7%, respectively (HR: 25.04 [2.58\u2013242.92], p &lt; 0.001). The corresponding rates for 10-year PFS were 58.6% and 85.6% in patients with post-RT ADC values below and above 1.24 \u00d7 10\u22123 mm2\/s (HR: 2.916 [1.113\u20137.644], p = 0.015). In the multivariate analysis, a post-treatment ADC value \u2264 1.24 \u00d7 10\u22123 mm2\/s was a significant prognostic factor for a lower PFS (HR: 3823 [1371\u201310,657], p = 0.010). Conclusions: This is the first study to show that post-RT ADC can be a predictive factor of local recurrence in PCa treated with RT and ADT. Moreover, this long-term study demonstrates its value as a predictive factor of progression in PCa treated with RT and ADT.<\/jats:p>","DOI":"10.3390\/cancers17050762","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T07:45:08Z","timestamp":1740469508000},"page":"762","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Apparent Diffusion Coefficient as an Early Predictive Factor of Local and Overall Response to Treatment with Androgen Deprivation Therapy and Radiotherapy in Patients with Prostate Cancer"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7505-8176","authenticated-orcid":false,"given":"Victor","family":"Duque-Santana","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Quir\u00f3nsalud Madrid y Hospital La Luz, 28223 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Universitario Quir\u00f3nsalud Madrid, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8453-5971","authenticated-orcid":false,"given":"Ana","family":"Diaz-Gavela","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Quir\u00f3nsalud Madrid y Hospital La Luz, 28223 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Recio","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"},{"name":"Department of Radiology, Hospital Universitario Quir\u00f3nsalud Madrid, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis L.","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Quir\u00f3nsalud Madrid y Hospital La Luz, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3102-4481","authenticated-orcid":false,"given":"Marina","family":"Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Quir\u00f3nsalud Madrid y Hospital La Luz, 28223 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Quir\u00f3nsalud Madrid y Hospital La Luz, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4077-0507","authenticated-orcid":false,"given":"Fernando","family":"L\u00f3pez-Campos","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6990-0619","authenticated-orcid":false,"given":"Israel J.","family":"Thuissard","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7558-4325","authenticated-orcid":false,"given":"Cristina","family":"Andreu-V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, Faculty of Biomedical and Health Sciences, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2177-5895","authenticated-orcid":false,"given":"David","family":"Sanz-Rosa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00e9rane","family":"Achard","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Institut Bergoni\u00e9, 33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1094-5839","authenticated-orcid":false,"given":"Alfonso","family":"G\u00f3mez-Iturriaga","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario de Cruces, 48903 Barakaldo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edctor","family":"D\u00edez","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Universitario Quir\u00f3nsalud Madrid, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-3673","authenticated-orcid":false,"given":"Barbara A.","family":"Jereczek-Fossa","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy"},{"name":"Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0942-0434","authenticated-orcid":false,"given":"Elia","family":"Del Cerro","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Quir\u00f3nsalud Madrid y Hospital La Luz, 28223 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-0234","authenticated-orcid":false,"given":"Felipe","family":"Cou\u00f1ago","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, 28108 Madrid, Spain"},{"name":"Department of Radiation Oncology, Hospital San Francisco de As\u00eds y La Milagrosa, GenesisCare, 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.eururo.2019.10.030","article-title":"ProtecT Study Group. Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received","volume":"77","author":"Neal","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.urology.2013.09.045","article-title":"The role of magnetic resonance imaging in delineating clinically significant prostate cancer","volume":"83","author":"Chamie","year":"2014","journal-title":"Urology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1056\/NEJMoa1801993","article-title":"MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis","volume":"378","author":"Kasivisvanathan","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3829","DOI":"10.1007\/s00345-023-04682-8","article-title":"Jorge clinical study: 10-year outcomes of risk-adapted radiotherapy defined by multiparametric MRI for prostate cancer","volume":"41","author":"Recio","year":"2023","journal-title":"World J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.radonc.2022.06.011","article-title":"The prognostic value of mean apparent diffusion coefficient measured with diffusion-weighted magnetic resonanceimage in patients with prostate cancer treated with definitive radiotherapy","volume":"173","author":"Onal","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/jmri.28093","article-title":"Repeatability and reproducibility assessment of the apparent diffusion coefficient in the prostate: A trial of the ECOG-ACRIN Research Group (ACRIN 6701)","volume":"56","author":"Boss","year":"2022","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1002\/jmri.28061","article-title":"Value of T(2) mapping MRI for prostate cancer detection and classification","volume":"56","author":"Klingebiel","year":"2022","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"20140359","DOI":"10.1259\/bjr.20140359","article-title":"Diffusion-weighted MRI in early assessment of tumour response to radiotherapy in high-risk prostate cancer","volume":"87","author":"Liu","year":"2014","journal-title":"Br. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/j.1754-9485.2010.02214.x","article-title":"Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2010 consensus guidelines for definitive external beam radiotherapy for prostate carcinoma","volume":"54","author":"Hayden","year":"2010","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.ijrobp.2006.04.029","article-title":"Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO Phoenix Consensus Conference","volume":"65","author":"Roach","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3610","DOI":"10.1007\/s00261-023-04002-z","article-title":"PSMA PET imaging in the diagnosis and management of prostate cancer","volume":"48","author":"Houshmand","year":"2023","journal-title":"Abdom. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Osama, S., Serboiu, C., Taciuc, I.A., Angelescu, E., Petcu, C., Priporeanu, T.A., Marinescu, A., and Costache, A. (2024). Current Approach to Complications and Difficulties during Transrectal Ultrasound-Guided Prostate Biopsies. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020487"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1007\/s00330-015-3688-1","article-title":"Prostate Cancer: Assessing the effects of androgen-deprivation therapy using quantitative diffusion-weighted and dynamic contrast-enhanced MRI","volume":"25","author":"Mazaheri","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"W477","DOI":"10.2214\/AJR.09.3557","article-title":"Assessment of response to radiotherapy for prostate cancer: Value of diffusion-weighted MRI at 3 T","volume":"194","author":"Song","year":"2010","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S179","DOI":"10.1102\/1470-7330.2010.9032","article-title":"Diffusion- weighted magnetic resonance imaging for tumor response assessment: Why, when and how?","volume":"10","author":"Afaq","year":"2010","journal-title":"Cancer Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1002\/jmri.21388","article-title":"ADC value and diffusion tensor imaging of pros- tate cancer: Changes in carbon-ion radiotherapy","volume":"27","author":"Takayama","year":"2008","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/jmri.21645","article-title":"Prediction of locally recurrent prostate cancer after radia- tion therapy: Incremental value of 3T diffusion-weighted MRI","volume":"29","author":"Kim","year":"2009","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e335","DOI":"10.1016\/j.ijrobp.2011.04.037","article-title":"Continued benefit to androgen deprivation therapy for prostate cancer patients treated with dose- escalated radiation therapy across multiple definitions of high-risk disease","volume":"81","author":"Stenmark","year":"2011","journal-title":"Int. J. Radiat. Oncol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.eururo.2019.10.008","article-title":"Local failure and survival after definitive radiotherapy for aggressive prostate cancer: An individual patient-level meta-analysis of six randomized trials","volume":"77","author":"Kishan","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.eururo.2022.07.011","article-title":"Local Failure Events in Prostate Cancer Treated with Radiotherapy: A Pooled Analysis of 18 Randomized Trials from the Meta-analysis of Randomized Trials in Cancer of the Prostate Consortium (LEVIATHAN)","volume":"82","author":"Ma","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_22","first-page":"4467","article-title":"Diffusion-weighted MRI and PSA correlations in patients with prostate cancer treated with radiation and hormonal therapy","volume":"32","author":"Iraha","year":"2012","journal-title":"Anticancer. Res."},{"key":"ref_23","unstructured":"(2025, February 19). An Efficacy and Safety Study of JNJ-56021927 (Apalutamide) in High-risk Prostate Cancer Subjects Receiving Primary Radiation Therapy: ATLAS. NCT02531516, Available online: http:\/\/clinicaltrial.gov\/."},{"key":"ref_24","unstructured":"(2025, February 19). Treatment of High-Risk Prostate Cancer Guided by Novel Diagnostic Radio-and Molecular Tracers (THUNDER). NCT06282588, Available online: http:\/\/clinicaltrial.gov\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1200\/JCO.20.02873","article-title":"Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: Results From the FLAME Randomized Phase III Trial","volume":"39","author":"Kerkmeijer","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ijrobp.2016.11.026","article-title":"Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): An Analysis of Survival Endpoints for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost to a Dose-Escalated External Beam Boost for High- and Intermediate-risk Prostate Cancer","volume":"98","author":"Morris","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/5\/762\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:41:14Z","timestamp":1760028074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/5\/762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,24]]},"references-count":26,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["cancers17050762"],"URL":"https:\/\/doi.org\/10.3390\/cancers17050762","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,24]]}}}