ACR Appropriateness Criteria ® Post-treatment Follow-up Prostate Cancer

Imaging, Expert Panel on Urologic

doi:10.1016/j.jacr.2018.03.019

Cited by 21 publications

(12 citation statements)

References 123 publications

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“…Since patients with a biochemical failure after RP undergo re-staging to rule out systemic disease before sRT [ 13 ], it would be desirable to have a diagnostic test that also addresses the presence of local disease. The identification along with the precise localisation of the disease within the prostatic fossa is supported by both the European Society Urologic Oncology and the American College of Radiology [ 14 , 15 ] since it may have prognostic value [ 16 , 17 ] and it may also optimise both sRT dose prescription and planning [ 18 , 19 ], although the role of a MR-directed boost to macroscopic disease remains undetermined.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study Assessing the Post-Prostatectomy Detection Rate of a Presumed Local Failure at mpMR with Either 64CuCl2 or 64CuPSMA PET/CT

Faiella

Sciuto

Giannarelli

et al. 2021

Cancers

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Background: We aimed assess the detection rate (DR) of positron emission tomography/computed tomography with two novel tracers in patients referred for salvage radiotherapy (sRT) with a presumed local recurrence at multiparametric magnetic resonance (mpMR) after radical prostatectomy (RP). Methods: The present prospective study was conducted at a single institution between August 2017 and June 2020. Eligibility criteria were undetectable PSA after RP; subsequent biochemical recurrence (two consecutive PSA rises to 0.2 ng/mL or greater); a presumed local failure at mpMR; no distant metastases at 18F-fluorocholine PET/CT (CH/PET); no previous history of androgen deprivation therapy. Patients were offered both 64CuCl2 PET/CT (CU/PET) and 64Cu-PSMA PET/CT (PSMA/PET) before sRT. After image co-registration, PET findings were compared to mpMR ones in terms of DR and independent predictors of DR investigated at logistic regression. Results: A total of 62 patients with 72 nodules at mpMR were accrued. Compared to mpMR (DR = 100%, 95%CI: 94.9–100%), DRs were 47.2% (95%CI: 36.1–58.6%) and 54.4% (95%CI: 42.7–65.7%) for CU/PET and PSMA/PET, respectively (p < 0.001 for both). Both experimental PET/CT performed particularly poorly at PSA levels consistent with early sRT. Conclusions: The two novel radiotracers are inferior to mpMR in restaging the prostatic fossa for sRT planning purposes, particularly in the context of early salvage radiotherapy.

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Section: Discussionmentioning

confidence: 99%

A Prospective Study Assessing the Post-Prostatectomy Detection Rate of a Presumed Local Failure at mpMR with Either 64CuCl2 or 64CuPSMA PET/CT

Faiella

Sciuto

Giannarelli

et al. 2021

Cancers

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“…A range of conventional and advanced imaging studies are available for evaluation of patients with suspected recurrent prostate cancer. Each examination has advantages and limitations (Table 2), and there are recently updated American College of Radiology guidelines for posttreatment imaging of prostate cancer (12).…”

Section: Imaging Modalities For Diagnosis Of Recurrence or Metastasismentioning

confidence: 99%

“…CT is not useful for detecting recurrent tumor in the surgical bed. In one series of 22 patients after radical prostatectomy, eight cases (36%) definitively classified as recurrent tumor showed very large recurrent masses (>2 cm) (12). CT also has poor sensitivity for nodal metastases from prostate cancer, since large numbers of metastatic nodes are known to be normal-sized, although CT is useful in following response of known enlarged metastatic lymphadenopathy to treatment and guiding percutaneous needle biopsy (5).…”

Section: Abdominopelvic Ct or Mri And Chest Imag-mentioning

confidence: 99%

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Current Imaging Techniques for and Imaging Spectrum of Prostate Cancer Recurrence and Metastasis: A Pictorial Review

et al. 2020

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Relapsing level of prostate-specific antigen (PSA) after initial curative-intent local therapy for organ-confined prostate cancer is often the first sign of recurrence. However, PSA level recurrence does not enable accurate differentiation of locally recurrent tumor from metastatic disease or a combination of both. Metastatic prostate cancer most frequently involves bones and lymph nodes, followed by other organs such as the liver, lung, pleura, adrenal gland, ureter, peritoneum, penis, testis, and meninges. Conventional imaging including CT and bone scintigraphy has long been the standard of care but has limited sensitivity in depicting early local recurrence or metastatic disease. Multiparametric MRI has been shown to be more sensitive in detecting locally recurrent tumor in the prostatectomy bed as well as in situ recurrence in a prostate gland that has been treated with radiation therapy or thermal ablation. In addition, lesions detected with multiparametric MRI may be amenable to targeted biopsy for definitive diagnosis of recurrence. PET/ CT or PET/MRI using the U.S. Food and Drug Administration (FDA)-approved tracers carbon 11 choline or fluorine 18 fluciclovine has demonstrated markedly increased sensitivity and specificity for diagnosis of early metastatic disease such as small-volume lymph node metastasis, as have a range of investigational gallium 68 prostate-specific membrane antigen (PSMA) radioactive PET tracers. With recent advances in imaging modalities and techniques, more accurate early detection, localization, and characterization of recurrent prostate cancer have become possible. The authors present a contemporary review of the strengths and limitations of conventional and advanced imaging modalities in evaluation of patients with recurrent prostate cancer and a systematic review of the clinical and imaging features of locally recurrent and metastatic disease. ©

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“…Standard workup of a rising PSA after RP includes pelvic imaging, most commonly MRI, to detect local recurrence within the surgical bed and pelvic lymph nodes, and whole-body imaging to evaluate for distant metastatic bone disease. Whole-body imaging techniques include technetium-99m-MDP bone scan and positron emission tomography (PET) scan using prostate-specific membrane antigen (PSMA), C-11 choline, or F-18 fluciclovine 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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

Nasser

Chernyak

Shankar

et al. 2020

CUAJ

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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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ACR Appropriateness Criteria ® Post-treatment Follow-up Prostate Cancer

Cited by 21 publications

References 123 publications

A Prospective Study Assessing the Post-Prostatectomy Detection Rate of a Presumed Local Failure at mpMR with Either 64CuCl2 or 64CuPSMA PET/CT

A Prospective Study Assessing the Post-Prostatectomy Detection Rate of a Presumed Local Failure at mpMR with Either 64CuCl2 or 64CuPSMA PET/CT

Current Imaging Techniques for and Imaging Spectrum of Prostate Cancer Recurrence and Metastasis: A Pictorial Review

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

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