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

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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Predictors of prostate bed nodule on MRI in patients with rising PSA after radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.122 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 122-122

Author(s):

Nicola Joseph Nasser ◽

Victoria Chernyak ◽

Shalom Kalnicki ◽

Jonathan Klein

Keyword(s):

Prostate Cancer ◽

African American ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Seminal Vesicle ◽

Metastatic Disease ◽

Biochemical Failure ◽

Pelvic Mri ◽

Prostate Bed ◽

Disease Characteristics

122 Background: Radical prostatectomy (RP) is a common treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole body imaging to rule out metastatic disease and pelvic MRI to detect local recurrence in the prostate bed. We analyzed disease characteristics and demographic data of patients with rising PSA after RP to determine correlation with MRI-detected cancer recurrence. Methods: Using Clinical Looking Glass, an institutional data registry query tool, we identified all MRI scans performed at our institution between January 2013 and January 2018 to evaluate for the presence of prostate cancer after RP due to rising prostate specific antigen (PSA) levels. Using Chi-square testing, we analyzed PSA levels, pathologic disease characteristics, time from surgery to biochemical failure, and patient demographic characteristics as predictors of local recurrence detected by pelvic MRI. Results: We identified 64 patients who underwent MRI for rising PSA and had complete clinical and pathological data available. A prostate bed nodule compatible with local recurrence was found in 17 patients (27%). Thirty-six patients (56%) had no evidence of tumor in the prostate bed or pelvis. Eleven patients (17%) had a suspicious lesion which could represent scarring, retained seminal vesicle or recurrent cancer. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p = 0.04) with African-American patients having 82% lower chance of MRI-detected tumor recurrence compared with White patients (p = 0.045). No other characteristic was significantly associated with MRI-detected recurrence including prostate cancer risk group, Gleason score, extra-capsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI. 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. This data may support a higher propensity toward microscopic metastatic disease at the time of biochemical failure in this population.

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Multiparametric magnetic resonance imaging in the diagnosis of local recurrence of prostate cancer in patients after radical prostatectomy

Cancer Urology ◽

10.17650/1726-9776-2015-11-4-72-80 ◽

2015 ◽

Vol 11 (4) ◽

pp. 72

Author(s):

G. I. Akhverdiyeva ◽

V. O. Panov ◽

I. E. Tyurin ◽

B. I. Dolgushin ◽

V. B. Matveyev ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Resonance Imaging ◽

Multiparametric Magnetic Resonance Imaging

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Evaluation of the Prostate Bed for Local Recurrence After Radical Prostatectomy Using Endorectal Magnetic Resonance Imaging

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.05.015 ◽

2013 ◽

Vol 85 (2) ◽

pp. 378-384 ◽

Cited By ~ 46

Author(s):

Stanley L. Liauw ◽

Sean P. Pitroda ◽

Scott E. Eggener ◽

Walter M. Stadler ◽

Charles A. Pelizzari ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Resonance Imaging ◽

Prostate Bed

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Detection of significant prostate cancer through magnetic resonance imaging targeted biopsy of PI-RADS3 lesions in African American patients based on prostate specific antigen density threshold of 0.15 ng/ml2: Analysis of patient population from the Vattikuti Urology Institute.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.286 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 286-286

Author(s):

Shaheen Riadh Alanee ◽

Musatafa Deebajah ◽

Zade Roumayah ◽

Ali Dabaja ◽

James O. Peabody ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

African American ◽

Magnetic Resonance ◽

Specific Antigen ◽

Lesion Size ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Prostate Specific Antigen Density ◽

Density Threshold

286 Background: A prostate specific antigen density (PSAD) threshold of 0.15 ng/ml2 have been suggested for significant cancer detection in PI-RADS 3 lesions to avoid unnecessary magnetic resonance imaging targeted biopsy (MRI-TB) of these lesions. However, the performance of this threshold in African American (AA) patients is not well characterized. Methods: We analyzed our institutional data base of MRI-TB to identify the rate of significant prostate cancer (Pca) detection in PI-RADS3 lesions in AA patients stratified by PSAD threshold of < 0.15 vs. ≥0.15 ng/ml2 and lesion size of < 1 cm vs ≥ 1 cm. Significant prostate cancer was defined as Gleason grade group 2 or higher on MRI-TB of the PI-RADS 3 lesion. Results: Of 768 patients included in the database, 211 (27.5%) patients identified themselves as AAs. Mean age of AA patients was 63 years and mean PSAD was 0.21. Sixty nine (32.7%) AA patients were found to have PI-RADS 3 lesions. Mean PSAD of AA patients with PI-RADS 3 lesions was 0.21 ng/ml2 as well. Fifty percent of AA patients with PI-RADS 3 lesions had PSAD ≥0.15 ng/ml2. Significant Pca detection rate for AA patients with PI-RADS 3 lesions was 9% for PSAD of ≥ 0.15 vs. 0.03% percent for AA patients with PSAD < 0.15 ng/ml2 (OR 7.056, CI 1.017-167.9, P=0.04). Stratification by lesion size (< 1 cm vs. > 1 cm) resulted in missing 0% percentage of significant Pca when only AA patients with PSAD ≥ 0.15 ng/ml2 and lesion size ≥ 1 cm received MRI-TB. Conclusions: We report on the performance of a reported PSAD density threshold in detecting significant Pca in one of the largest series of AA patients receiving MRI-TB of the prostate. Our results have direct clinical implications when counseling AA patients with PI-RADS 3 lesion on whether they should undergo MRI-TB of such lesions.

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