Prostate MRI & Recurrence
Jurgen F├╝tterer1

1Radboud Univ. Nijmegen Medical Centre, Netherlands

Synopsis

mpMRI is a helpful tool in the evaluation of the treated prostate gland.

Abstract

The increasing incidence of prostate cancer, which is the most frequently diagnosed malignancy in the western male population 1, poses an increasing burden on healthcare. Prostate specific antigen (PSA) screening and multiparametric magnetic resonance imaging (mpMRI)-guided biopsy are revealing more and more patients with this disease. As long as prostate cancer is confined to the prostate treatment of the disease has a curative intent. Clinically localized prostate cancer is typically managed by whole gland therapies like radical prostatectomy or a form of radiotherapy (protonbeam therapy, brachytherapy or external beam radiotherapy). Approximately 30% of patients who undergo radical prostatectomy will develop biochemical recurrent disease 2. Biochemical failure, i.e. a rising serum PSA in the absence of demonstrable metastases, is widely accepted as an appropriate endpoint for defining treatment failure in men with localized prostate cancer. The serum PSA is routinely used to monitor disease recurrence after definitive therapy because biochemical recurrence antedates metastatic disease progression and prostate cancer–specific mortality by an average of 7 and 15 years, respectively. Patients with biochemical recurrence after radical prostatectomy have an 88% 10-year overall survival rate compared to a 93% in males without signs of biochemical recurrence. Approximately 25-30% of patients with newly diagnosed prostate cancer undergo external beam radiation therapy as their definitive treatment. Unfortunately, up to 50% of patients develop biochemical failure, presumably due to local recurrence after 5 years. Currently, serum PSA increase after radiotherapy is the best indicator of biologically active tumor. Whenever such an elevation of serum PSA after nadir has taken place, imaging is required to investigate whether this increase is due to local or systemic recurrent disease. Local recurrence (30%) may be amenable to salvage therapy, while systemic recurrence may be an indication for systemic treatment. The emergence of novel local salvage therapeutic options, such as high intensity focused ultrasound, laserablation or cryosurgery, is an additional factor driving the increased interest in a more detailed evaluation of the prostate or prostatic bed. The ability to detect or exclude local recurrence within the prostate by mpMRI imaging could facilitate salvage treatment, or potentially facilitate systemic therapy in patients with presumed distant failure based on biochemical failure in the absence of detectable local recurrence, ultimately improving the care and lives of patients with prostate cancer. This review will discuss the role of MR imaging in patients experiencing recurrent prostate cancer.

Acknowledgements

No acknowledgement found.

References

1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. Jan 2017;67(1):7-30. 2. Djavan B, Moul JW, Zlotta A, Remzi M, Ravery V. PSA progression following radical prostatectomy and radiation therapy: new standards in the new Millennium. Eur Urol. Jan 2003;43(1):12-27.

Proc. Intl. Soc. Mag. Reson. Med. 26 (2018)