Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy.

Abstract

The aim of this study was to evaluate CT imaging in the post-operative follow-up and in the detection of recurrence after radical prostatectomy in cases of prostatic carcinoma. In over 500 patients undergoing radical prostatectomy for prostatic carcinoma, 22 cases with local recurrence were found. CT examinations of the pelvis were retrospectively evaluated in these patients. Local recurrence was detected by PSA uptake and confirmed by transrectal ultrasound (TRUS) in combination with guided biopsy. In 22 cases of confirmed local recurrence, positive results on CT were found in eight patients (36%) and negative results in nine patients (41%). In the remaining five cases (23%), no distinction could be made between scar and local recurrence. All cases definitively classified as recurrent tumour disease showed a soft tissue mass of 2 cm or more. CT sensitivity in local recurrence of prostatic carcinoma after surgery is low. Even in a very careful follow-up, the understaging would be up to 41%. In comparison, PSA, TRUS and needle biopsy are the methods of choice and are superior to CT imaging. Based on these results, there would be no reason for including pelvic CT examinations in the follow-up of prostatic carcinoma after radical prostatectomy.

Management of biochemical failure following radical prostatectomy: salvage radiotherapy – a case series

“…12 Even in patients with palpable biopsy proven relapse, CT scanning is unlikely to differentiate between recurrence and scar tissue. 13 For patients with localized recurrence following RP, salvage RT offers the only potential chance of cure for patients with isolated local recurrence. Early studies with small patient numbers were associated with disappointing results, largely because of poor selection of patients including those with a high risk of disseminated disease.…”

Postradical prostatectomy TRUS-guided anastomotic biopsy. Where do we stand today?

“…CT is not sufficiently sensitive in recognizing local disease recurrence following radical prostatectomy for prostatic carcinoma, 43 although it still plays a part in the planning of radiation treatment in confirmed local recurrence. 43 Preliminary data show that PET may be more sensitive than CT for the detection of lymph node metastasis, but bladder activity poses a serious problem in the identification of local prostate cancer recurrence.…”

“…43 Preliminary data show that PET may be more sensitive than CT for the detection of lymph node metastasis, but bladder activity poses a serious problem in the identification of local prostate cancer recurrence. 44 MR imaging evaluation either with a transrectal surface coil 45 or a body coil, 46 is a useful imaging tool to study the anatomy of vesicourethral anastomosis in men after radical prostatectomy, suspected of local recurrence (Figure 4).…”

Local therapy for prostate-specific antigen recurrence after definitive treatment

“…Likewise, crosssectional imaging to detect local recurrence or lymphadenopathy is fairly insensitive (60% and 30 ± 80%, respectively) and plays a greater role in men with higher PSA elevations and shorter PSA doubling time. 46,47 As technology evolves in high resolution scanners, MRI, and magnetic resonance spectroscopy, so will their role in visualizing local and distant recurrence.…”