Advances in imaging and in non-surgical salvage treatments after radiorecurrence in prostate cancer: what does the oncologist, radiotherapist and radiologist need to know?

Abstract

Imaging may influence therapeutic decisions during non-surgical STs. MRI findings correlate with parametric maps derived from multiple functional techniques. Non-surgical salvage treatments allow local tumour control in patients with radiorecurrent PCa.

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

“…Local salvage therapies with curative intent include additional irradiation of the prostate, RP, and other new treatment options such as cryosurgery, transrectal high-intensity focused US, photodynamic therapy and radiofrequency interstitial, and microwave thermoablation [72]. Because the exact location of the recurrent tumor within the prostate is generally unknown, the general practice of salvage therapies involves treatment of the entire prostate [73].…”

Magnetic resonance imaging for localization of prostate cancer in the setting of biochemical recurrence

“…In patients with local recurrence after RT, if local salvage therapy is not undertaken early, then the median time to development of distant metastases is E3 years [26]. Local salvage therapies with curative intent include additional irradiation of the prostate, RP, and other new treatment options such as cryosurgery, transrectal high-intensity focused ultrasound trans-rectal ultrasonography guided (TRUSguided) and laser therapy [27]. As the exact location of the recurrent tumor within the prostate is generally unknown, the general practice of salvage therapies involves treatment of the entire prostate [27].…”

Advances in Prostate Cancer Research and Treatment

“…We now have a greater understanding of mechanisms sustaining the biological processes responsible for tumor progression [7–12] or towards a biological aggressive or radio resistant phenotype [13–15]. However, we are aware that the improvement in oncological outcome of men who remain at high risk for systemic failure may be achieved by improving each diagnostic and therapeutic step including the diagnostic performances of conventional imaging modalities [16]. To date, conventional anatomic imaging techniques of computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) are currently used in the common clinical practice to stage men suffering from Pca [17–20].…”

“…All these diagnostic tools have peculiar advantages and disadvantages although they play a rather limited role in monitoring men with Pca [17–20]. These limitations are attributable to the incapacity to distinguish malignant from the surrounding nonmalignant tissue [16–20]. The close integration between molecular biology and clinical imaging may ease the development of new molecular imaging agents useful in monitoring a number of biological events that, until a few years ago, were studied by conventional molecular assays [17].…”

“…The close integration between molecular biology and clinical imaging may ease the development of new molecular imaging agents useful in monitoring a number of biological events that, until a few years ago, were studied by conventional molecular assays [17]. With regard to Pca, progress in quantification, characterization, and timing of biological processes may be obtained overcoming problems related to the amplification of low level signals of in vivo biological events, the development of integrated imaging platforms with sufficiently high spatial and temporal resolution [18], and the need to reach the target in vivo to achieve satisfactory specificity [16–20]. …”