Diagnosis of recurrent prostate cancer and its mimics at multiparametric prostate MRI

Abstract

Biochemical recurrence after treatment for prostate cancer (PCa) is a significant issue. Early diagnosis of local recurrence is important for making prompt treatment decisions and is strongly associated with patient prognosis. Without salvage therapy, the average time from development of local recurrence to distant metastasis is approximately 3 years. Biochemical recurrence does not differentiate local recurrence from systemic disease; there is no reliable way to clinically diagnose local recurrence. Recent advances in multiparametric MRI (mp-MRI) techniques have markedly improved detection of local recurrence following therapy. However, a wide variety of entities can mimic recurrent PCa at mp-MRI. Therefore, the purpose of this pictorial review is to discuss the MRI findings of locally recurrent PCa and its mimics, emphasizing the key MRI features that help to differentiate local recurrence from its mimics.

Multiparametric Magnetic Resonance Imaging of Recurrent Prostate Cancer

“…Signal characteristics of recurrent tumors are similar to those of the initial tumor; although they are often less conspicuous without a background of normal prostatic tissue for comparison. DCE MRI is the most useful MRI sequence, as residual/recurrent tumors will enhance in the early arterial phase while fibrosis will either not enhance or enhance very slowly and uniformly(11). Recurrent masses show early arterial and intense contrast enhancement compared to surrounding tissues and may washout earlier (27, 31, 32).…”

“…The mpMRI can be fused to transrectal ultrasound (TRUS) to enable fusion image guided biopsy of MR-defined lesions (8). Recent studies have also suggested that mpMRI can also be used in the evaluation of recurrent or residual disease (9-11). However, treatment induced changes including distorted anatomy, fibrosis, artifacts from surgical clips, and alteration of the signal characteristics on MRI can complicate the interpretation.…”

Salvage high-dose-rate brachytherapy for histologically confirmed macroscopic local relapsed prostate cancer after radical prostatectomy

“…On the other hand, recent advances in multiparametric magnetic resonance imaging (mpMRI) and choline positron emission tomography/computed tomography (PET/CT) have markedly improved detection of local and distant recurrence following therapy [13]. Therefore, choline PET/CT and mpMRI have an important role in the detection and location of recurrences at this moment, allowing a better selection of candidates for local salvage treatment [14].…”

Prostat Kanserinde Tedavi Sonrasi Goruntulume

“…[15] RP sonrası lokal relapsı araştırdıkları çalışmasında, T2A'ya DCE'nin eklenmesiyle sensitivite %61,4'ten %84,1'e, spesifite %82,1'den 89,3'e, genel doğruluk da %69,4'ten %86,1'e yükselmiştir. DCE, nüks-rekürensi saptamada en başarılı sekans olarak öne çıkmaktadır [16][17][18][19]. DCE'de fibrotik doku yavaş ve geç kontrastlanırken, reküren tümör dokusu erken arteryel fazda yoğun parlaklaşma gösterir ve erken yıkanır [16,19,20].…”

“…DCE, nüks-rekürensi saptamada en başarılı sekans olarak öne çıkmaktadır [16][17][18][19]. DCE'de fibrotik doku yavaş ve geç kontrastlanırken, reküren tümör dokusu erken arteryel fazda yoğun parlaklaşma gösterir ve erken yıkanır [16,19,20]. DAG artefaktlı değilse, rekürensi değerlendir-mede yerini korumaktadır; yüksek b değerli görüntülerde parlak, ADC'de düşük sinyal rekürens bulgularıdır.…”