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

Abstract

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.

Predictors of PSMA PET Positivity: Analysis in a Selected Cohort of Biochemical Recurrence Prostate Cancer Patients after Radical Prostatectomy

“…Patients showing BCR of PCa have a higher risk of developing distant metastases and PCa-related death [ 3 , 4 ]. Several clinical parameters including serum prostate-specific antigen (PSA) levels, PSA kinetics, and the International Society of Urological Pathology (ISUP) score have been shown to predict the risk of PCa recurrence after RP [ 5 , 6 , 7 , 8 ].…”

Pathological predictors of 18F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

“…Identifying factors predicting positive-PSMA imaging with respect to site in BF could aid appropriate patient selection for PSMA imaging in resource limited health systems. Factors that predict BF after RP in general include pre-treatment PSA level, short PSA-doubling time (PSAdt), time interval from RP to BF (IBF), and pathological features of the original tumour specimen including Gleason score, pathological T stage, extracapsular extension (ECE), seminal vesicle involvement (SVI), surgical margin positivity, and lymph node involvement [17][18][19]. These factors have been used to create risk groups and nomograms predicting postoperative prostate cancer-specific mortality (PCSM); however, such models are unable to predict the site and extent of disease.…”