Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy

Abstract

Purpose/ObjectiveLittle is known about the clinical impact of using multiparametric MRI to plan early salvage radiotherapy after radical prostatectomy. We aimed to evaluate the incidence and location of recurrence based on pelvic multiparametric MRI findings and to identify clinical variables predictive of positive imaging results.Materials and methodsWe defined radiological criteria of local and lymph node malignancy and reviewed records and MRI studies of 70 patients with PSA recurrence after radical prostatectomy. We performed univariate and multivariate analysis to identify any association between clinical, pathological and treatment-related variables and imaging results.ResultsMultiparametric MRI was positive in 33/70 patients. We found local and lymph node recurrence in 27 patients and 7 patients, respectively, with a median PSA value of 0.38 ng/ml. We found no statistically significant differences between patients with positive and negative multiparametric MRI for any variable. Shorter PSADT was associated with positive lymph nodes (median PSADT: 5.12 vs 12.70 months; p: 0.017).ConclusionsNearly half the patients had visible disease in multiparametric MRI despite low PSA. Positive lymph nodes incidence should be considered when planning salvage radiotherapy, particularly in patients with a short PSADT.

Localizing sites of disease in patients with rising serum prostate-specific antigen up to 1 ng/ml following prostatectomy: How much information can conventional imaging provide?

“…The sensitivity of MRI for local recurrence and pelvic lymph node metastases was 89% and 64%, respectively [9]. Hernandez et al evaluated 70 patients with a median PSA of 0.38 (range 0.00–8.05), and identified 7 (10%) of patients with nodal metastases [25]. There was no pathologic correlation for the nodal findings, and it is unclear if patients receiving ADT at the time of imaging were included in the analysis.…”

Evaluation of tumor recurrences after radical prostatectomy using 18F-Choline PET/CT and 3T multiparametric MRI without endorectal coil: a single center experience

“…In fact, although we only found an association between PSA values at the time of biochemical failure and MRI positivity, many studies have reported an association between PSA and choline PET/CT [22]. Thus, after RP, the optimal PSA cut-off level for choline PET/CT analysis seems to be between 1 and 2 ng/mL [23], while for MRI, the corresponding value appears to range from 0.3 to 0.54 ng/mL [5]. In addition to the PSA value, several studies have reported that PSA kinetics (PSADT, PSA velocity) are strong predictors for positive PET and MRI findings, even in patients with low PSA values [4, 5, 23].…”

“…Thus, after RP, the optimal PSA cut-off level for choline PET/CT analysis seems to be between 1 and 2 ng/mL [23], while for MRI, the corresponding value appears to range from 0.3 to 0.54 ng/mL [5]. In addition to the PSA value, several studies have reported that PSA kinetics (PSADT, PSA velocity) are strong predictors for positive PET and MRI findings, even in patients with low PSA values [4, 5, 23]. We found that PSADT was significantly associated with the type of pelvic recurrence: patients with a higher PSADT had an increased probability of local recurrence.…”

“…LR was measured using the T2, DWI and DCE sequences while LNR and BM were assessed with T2 and DWI sequences. There is no validated scoring system to define a recurrence after RP on mpMRI [5]; consequently, we used the following mpMRI criteria for LR: presence of a soft tissue nodule on T2-weighted images in or around the prostatectomy bed in T2-weighted images; the presence of an area or hyperintense nodular lesion on the diffusion map, and a hypointense lesion on the ADC map with low ADC values and a DCE image showing an intense, early enhancement with plateau (type 2 curve) or posterior washing (type 3 curve). LR was positive considered when two or more sequences were abnormal.…”

“…Multiparametric MRI has proven useful in the detection of LR in the prostate gland, even in patients with low prostate-specific antigen (PSA) levels (<0.5 ng/mL) [4], although few studies have assessed the value of mpMRI to LNR or pelvic bone BM [2, 5]. By contrast, 18F-CH PET/CT has proven effective in detecting LNR and BM after RP, primarily in patients with PSA >1 ng/mL or with PSA doubling time (PSADT) < 6 months [6].…”