Advanced Imaging for the Early Diagnosis of Local Recurrence Prostate Cancer after Radical Prostatectomy

Currently the diagnosis of local recurrence of prostate cancer (PCa) after radical prostatectomy (RT) is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA) higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI) in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence.

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Multiparametric MRI for Recurrent Prostate Cancer Post Radical Prostatectomy and Postradiation Therapy

BioMed Research International ◽

10.1155/2014/316272 ◽

2014 ◽

Vol 2014 ◽

pp. 1-23 ◽

Cited By ~ 28

Author(s):

Flavio Barchetti ◽

Valeria Panebianco

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Locoregional Recurrence ◽

Multiparametric Mri ◽

Cochrane Library ◽

Published Data ◽

Detection And Localization ◽

The Impact

The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.

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O uso do PET/CT com PSMA 68GA no reestadiamento do câncer prostático em pacientes com recidiva bioquímica após prostatectomia radical / The use of PET / CT with PSMA 68GA in prostate cancer rehability in patients with received biochemical after radical prostatectomy

Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo ◽

10.26432/1809-3019.2021.66.005 ◽

2021 ◽

Vol 66 (1u) ◽

pp. 1

Author(s):

Gesislania De Sousa ◽

Erik Lima ◽

Felipe Favaro Capeleti ◽

Rafael Eidi Goto ◽

Homero José de Farias e Melo ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Treatment Change ◽

Detection Rates ◽

Therapeutic Decisions ◽

Pubmed Database ◽

Pet Ct ◽

The Impact

Introdução: O Câncer de Próstata (CP) é o tumor maligno mais comum na população masculina acima dos 50 anos, sendo o adenocarcinoma o tipo histológico responsável por cerca de 95% dos casos. É o terceiro câncer com maior taxa de mortalidade entre os homens no mundo. A recorrência bioquímica do CP após prostatectomia radical é um problema clínico relevante. Objetivo: essa revisão teve como objetivo descrever o uso PET/CT-PSMA-68Ga no reestadiamento do CP nos casos de recidiva bioquímica após prostatectomia. Método: realizamos uma revisão bibliográfica na base de dados da PubMed, nos últimos três anos, de artigos publicados na íntegra. Resultados: Treze artigos foram usados na análise, a média da taxa de positividade do PET entre os estudos foi de 67.9%, variando de 34.4% a 89.5%. Discussão: todos os estudos concordam que maiores taxas de detecção foram diretamente proporcionais aos valores de PSA. Sete artigos mensuraram o impacto do PSMA na mudança terapêutica com uma média de 66.5% de alteração do tratamento (de 28.6% a 87.7%). Conclusão: Com base na análise dos artigos concluiu-se que o PET/CT-PSMA- - 68Ga na recorrência bioquímica do CP é útil na detecção de lesões locais e/ou metastáticas, e ainda importante no reestadiamento contribuindo nas decisões terapêuticas futuras.Palavras chave: Neoplasia prostática, Tomografia computadorizada, Recorrência, Bioquímica, PET/CT, Antígeno prostático específico Introduction: Prostate cancer (CP) is the most common malignant tumor in the male population over 50 years old, with adenocarcinoma being the histological type responsible for about 95% of cases. It is the third cancer with the highest mortality rate among men in the world. Biochemical recurrence of PC after radical prostatectomy is a relevant clinical problem. Objective: this review aimed to define the use of PET / CT-PSMA-68Ga without PC restaging in cases of biochemical recurrence after prostatectomy. Method: we performed a bibliographic review in the PubMed database, in the three years, of articles published in full. Results: Thirteen articles were used in the analysis, the average PET positivity rate between studies was 67.9%, varying from 34.4% to 89.5%. Discussion: all studies agree that higher detection rates were directly proportional to the PSA values. Seven articles measured the impact of PSMA on therapeutic change with an average of 66.5% of treatment change (from 28.6% to 87.7%). Conclusion: Based on the analysis of the concluded articles, PET / CT-PSMA-68Ga in the biochemical recurrence of PC is useful in the detection of sites and / or metastases, and also important in restaging, contributing to future therapeutic decisions. Keywords: Prostatic neoplasms, Computed tomography, Recurrence, Biochemistry, PET/CT, Prostate-specific antigen

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68 Ga‐PSMA‐PET/CT helps to select patients for salvage radical prostatectomy with local recurrence after primary radiotherapy for prostate cancer

BJU International ◽

10.1111/bju.15135 ◽

2020 ◽

Vol 126 (6) ◽

pp. 679-683

Author(s):

David Pfister ◽

Friederike Haidl ◽

Tim Nestler ◽

Frederik Verburg ◽

Matthias Schmidt ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Psma Pet ◽

Pet Ct ◽

Primary Radiotherapy ◽

Salvage Radical Prostatectomy

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Study of PSMA-targeted 18F-DCFPyL PET/CT in the evaluation of men with an elevated PSA following radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.299 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 299-299

Author(s):

Michael A. Gorin ◽

Steven P. Rowe ◽

Margarita Mana-ay ◽

Zsolt Szabo ◽

Edward M. Schaeffer ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Bone Scan ◽

Conventional Imaging ◽

Imaging Test ◽

Imaging Results ◽

Pet Ct ◽

Bony Lesions

299 Background: Positron emission tomography/x−ray computed tomography (PET/CT) utilizing radiotracers targeting prostate membrane specific antigen (PSMA) offer the promise of improved sensitivity for visualizing low volume sites of prostate cancer. In this study we evaluated the sensitivity of PET/CT using 18F-DCFPyL, a novel small molecule ligand of PSMA, for imaging sites of disease in men with an elevated PSA following radical prostatectomy. Methods: Patients with an elevated PSA following radical prostatectomy (defined as ≥ 0.2 ng/mL) were imaged with CT or magnetic resonance imaging (MRI) of the abdomen and pelvis, 99mTc-methylene diphosphonate bone scan and 18F-DCFPyL PET/CT. Conventional imaging studies (CT, MRI and boen scan) were clinically reviewed by readers blinded to the PET/CT scan results. Similarly, PET/CT scans were blindly reviewed and then the sensitivity of this novel imaging test was compared to that of conventional imaging. Results: In total, 12 men with a median PSA of 0.34 ng/mL (range 0.2 to 11) were imaged as part of this study. 2 (16.7%) patients had persistently elevated PSA values after surgery and 10 (83.3%) had values which were initially undetectable but then rose to ≥ 0.2 ng/mL. On conventional imaging, only 4 (25.0%) patients had at least 1 detectable site of disease. This included 1 patient with a local recurrence detected on MRI and 3 patients with bony lesions detected on bone scan. In contrast, 9 (75.0%) patients had areas of detectable disease on PET/CT. This included 3 (25.0%) patients with a local recurrence, 3 (25.0%) with lymph node metastases, 2 (16.7%) with bony lesions and 1 (8.3%) with both lymph node and bone findings. All lesions detected on conventional imaging had corresponding areas of radiotracer uptake on PET/CT. Conclusions: 18F-DCFPyL PET/CT appears to be more sensitive for detecting areas of prostate cancer recurrence in patients with an elevated PSA following radical prostatectomy. Future work aims to more precisely define the sensitivity of this imaging test in a larger patient cohort. Clinical trial information: NCT02523924.

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Advancing age and the risk of adverse pathology at radical prostatectomy in men with biopsy Gleason score 6 prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.289 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 289-289

Author(s):

Daniel Kim ◽

Ming-Hui Chen ◽

Hartwig Huland ◽

Markus Graefen ◽

Derya Tilki ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Cancer Center ◽

Study Cohort ◽

Pathologic Features ◽

Younger Men ◽

Biopsy Gleason Score ◽

The Impact

289 Background: We evaluated the impact of age > 65 years versus younger on the odds of finding adverse pathologic features (pT3/T4 and/or R1 and/or Gleason score 8, 9, 10) at radical prostatectomy (RP) among men with biopsy Gleason score 6 prostate cancer (PC). Methods: The study cohort comprised 3191 men with biopsy Gleason score 6 PC treated with a RP between February 28, 1992 and February 15, 2016 at the Martini-Klinik Prostate Cancer Center. Multivariable logistic regression was used to evaluate the impact of age > 65 years versus younger on the adjusted odds ratio (AOR) of finding adverse pathology at RP adjusting for pre-RP prostate specific antigen (PSA), clinical tumor category, year of diagnosis, percent positive biopsies (PPB), and PSA density (PSAd). Results: Men age > 65 years as compared to younger had significantly lower median PPB (16.67% vs 20.0%; p = 0.01) and PSAd (0.13 ng/mL vs 0.15 ng/mL; p < 0.0001). Yet, while both increasing PPB (AOR 1.018, 95% CI 1.013, 1.023; p- < 0.0001) and PSAd (AOR 4.28, 95% CI 1.66, 11.01; p = 0.003) were significantly associated with an increased odds of finding adverse pathology at RP, men age > 65 years versus younger had a higher odds of adverse pathology at RP (AOR 1.28, 95% CI 1.002, 1.62; p = 0.048). Conclusions: Despite a more favorable median PPB and PSAd, men with biopsy Gleason score 6 PC and who are age > 65 years compared to younger men are at higher risk for having adverse pathology at RP and may benefit from a multiparametric MRI and targeted biopsy before proceeding with active surveillance. If higher grade/stage disease is discovered and treatment indicated then this information could guide both the use and duration of supplemental androgen deprivation therapy in men considering radiation therapy.

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Role of Salvage Radical Prostatectomy for Recurrent Prostate Cancer After Radiation Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.1468 ◽

2005 ◽

Vol 23 (32) ◽

pp. 8198-8203 ◽

Cited By ~ 87

Author(s):

Andrew J. Stephenson ◽

James A. Eastham

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Salvage Therapy ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Cancer Control ◽

Increased Risk ◽

Salvage Radical Prostatectomy

Patients with isolated local recurrence of prostate cancer after radiation therapy may potentially be cured of their disease by salvage radical prostatectomy (RP). The stage-specific 5-year cancer-control rates of salvage RP resemble those of standard RP. However, the ability to effectively administer salvage treatment to patients with radiorecurrent disease is compromised by the lack of diagnostic tests with sufficient sensitivity and specificity to detect local recurrence at an early stage while it is amenable to local salvage therapy. By the time biochemical recurrence is declared using the current American Society for Therapeutic Radiology and Oncology definition, the majority of patients have advanced local disease, precluding successful local salvage therapy. When salvage RP is performed at prostate-specific antigen levels of 10 ng/mL or less, an estimated 70% of patients are free of disease at 5 years. With better patient selection and technical modifications, the morbidity associated with salvage RP has improved substantially. Rates of urinary incontinence and anastomotic stricture are acceptable, although one third of patients will experience these complications. Salvage cryotherapy is a minimally invasive alternative to salvage RP, but cancer-control rates appear to be inferior and it does not provide a clear advantage over salvage RP in terms of reduced morbidity. Patients with local recurrence after radiation therapy are at increased risk of metastatic progression and cancer-specific mortality. Currently, salvage RP represents the only curative treatment option for these patients. Salvage RP may favorably alter the natural history of biochemical recurrence after radiation therapy, but it must be instituted early in the course of recurrent disease to be effective.

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Predictors of prostate bed recurrence on magnetic resonance imaging in patients with rising prostate-specific antigen after radical prostatectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.6463 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Nicola J. Nasser ◽

Victoria Chernyak ◽

Viswanathan Shankar ◽

Madhur Garg ◽

William Bodner ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

African American ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Specific Antigen ◽

Biochemical Failure ◽

Resonance Imaging ◽

Prostate Bed ◽

Disease Characteristics

Introduction: Radical prostatectomy (RP) is a standard treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole body imaging to exclude distant metastatic disease, and pelvic magnetic resonance imaging (MRI) to detect local recurrence in the prostatectomy bed. The goal of this study is to correlate disease characteristics and demographic data in patients with rising prostate-specific antigen (PSA) after RP to determine association with MRI-detected cancer recurrence. Methods: Sixty-four patients who underwent pelvic MRI for rising PSA after RP and had complete clinical and pathological data available were included. Using Chi-squared testing, we analyzed PSA levels, pathological disease characteristics (prostate cancer risk group, Gleason score, extracapsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI), time from surgery to biochemical failure, and patient demographic characteristics as potential predictors of MR-detected local recurrence. Results: Definite MRI-detected local recurrence was observed in 17/64 patients (27%). Eleven (17%) patients had a suspicious lesion with the differential of scarring, retained seminal vesicle, or recurrent cancer. Thirty-six (56%) patients had no evidence of tumor in the prostate bed or pelvis on MRI. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p=0.04), with African-American patients having 82% lower odds of MRI-detected tumor recurrence compared with White patients (p=0.045). No other tumor or patient characteristic was significantly associated with MRI-detected recurrence. Conclusions: African-American patients with biochemical failure after RP are less likely to have MRI-detectable recurrence in the prostate bed compared with White patients.

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Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

Canadian Urological Association Journal ◽

10.5489/cuaj.4641 ◽

2017 ◽

Vol 12 (2) ◽

pp. 45-9

Author(s):

Khaled Ajib ◽

Marc Zanaty ◽

Mansour Alnazari ◽

Emad Rajih ◽

Pierre-Alain Hueber ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

External Beam Radiotherapy ◽

Specific Antigen ◽

Urinary Continence ◽

Robot Assisted ◽

Time Points ◽

Canadian Experience ◽

Significant Difference ◽

The Impact

Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP).Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (prostate- specific antigen [PSA]) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status.Results: Men who underwent SRT had a mean age, PSA, and time from radical prostatectomy (RP) to RT of 61.8 years (60.1‒63.6), 0.5 ng/ml (0.2‒0.8), and 458 days (307‒747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL, was observed in 89%, 93%, and 81%, at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months was 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3 (p=0.61). The mean SHIM score pre-SRT was comparable at all time points following treatment (p=0.86).Conclusions: In this unique Canadian experience, it appears that early SRT is highly effective for the treatment of BCR following RARP with little impact on urinary continence and potency outcomes.

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