Combined Whole Body and Multiparametric Prostate Magnetic Resonance Imaging as a 1-Step Approach to the Simultaneous Assessment of Local Recurrence and Metastatic Disease after Radical Prostatectomy

Abstract

Purpose To report our initial experience using “whole body and dedicated prostate (WB+P)” MRI as a single exam for the assessment of local recurrence and metastatic disease in patients with suspected recurrent prostate cancer (PCa) after radical prostatectomy (RP). Materials and Methods IRB-approved retrospective single-center study. 76 consecutive patients with clinically suspected recurrent PCa following RP underwent combined WB+P-MRI in a single session (10/2014-01/2016). WB+P-MRI scans were evaluated for the detection of disease in the prostate bed, regional nodes and distant sites. Comparison was made to other imaging tests and prostate bed, node and bone biopsies, performed within 90-days. Results and Conclusions WB+P-MRI was completed successfully in all patients. Median PSA was 0.36 ng/ml (range:<0.05-56.12). WB+P-MRI identified suspected disease recurrence in 16/76 (21%) of patients (local recurrence in the RP bed in 6/76, nodal metastases in 3/76, osseous metastases in 4/76, and multifocal metastatic disease in 3/76). 43 patients had at least one standard staging scan in addition to WB+P-MRI, with concordance demonstrated between imaging modalities in 36/43(84%). All metastatic lesions detected on other imaging tests were detected on WB+P-MRI. In addition, WB+P-MRI detected osseous metastases in 4 patients with false-negative findings on other imaging tests (including 2 bone scans and 3 CT scans), and excluded osseous disease in 1 patient with a positive 18F-FDG-PET/CT, and subsequent negative bone biopsy. Whole body and pelvic (WB+P) MRI is feasible in a clinical practice setting, and can provide incremental information when compared to standard imaging in men with suspected PCa recurrence following RP.

The Contribution of Multiparametric Pelvic and Whole-Body MRI to Interpretation of 18F-Fluoromethylcholine or 68Ga-HBED-CC PSMA-11 PET/CT in Patients with Biochemical Failure After Radical Prostatectomy

“…Dedicated fusion software enabled multimodality image fusion when needed. Previous studies have shown that when the serum PSA level is 1 ng/mL or less, mpMR detects local recurrence in the prostatic bed in 11%-21% of patients (6,7). Our results were similar, with a detection rate of 15.1% for the entire cohort.…”

Use of modern imaging methods to facilitate trials of metastasis-directed therapy for oligometastatic disease in prostate cancer: a consensus recommendation from the EORTC Imaging Group

“…The role of imaging in these cases is critical. Imaging firstly should be to rule--out poly--metastatic disease not amenable to cure by local treatment alone, and to detect OMD that could benefit from regional salvage therapies 75,76,77 . The detection of OMD at BCR is important since at least one trial has demonstrated that MDT could delay initiation of ADT 8 .…”

“…WB--MRI can detect metastases at BCR even at (very) low PSA values (median 0.36 ng/ml) 76 (Figure A2). A WB--MRI based study evaluating the distribution of bone and node recurrence showed that metastatic disease was often distant, located beyond usual surgical and radiotherapeutic boundaries for treating BCR 12 .…”

Imaging for Metastasis in Prostate Cancer: A Review of the Literature

“…In a study of 76 consecutive patients with suspected PCa recurrence after RP, WB and dedicated prostate MRI was completed successfully in all patients. Suspected disease recurrence was identified in 21% (16/76) of patients, including local recurrence in the prostate bed in 8% (46).…”